Release of InformationStudent Information(*required fields)First NameLast NameMiddle InitialStudent IDStar IDEmail AddressBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900I hereby authorize Minnesota State Community and Technical College (M State) to release and/or orally discuss the education records described below about me to:Release InformationDelete_ID_NameRelationshipDepartment (list N/A if none)The specific records covered by this release are:The specific records covered by this release are:Accounts Receivable (itemized charges or credits)Financial AidRegistration (add/drop/withdrawal)Grade Reports (end of semester)Faculty (Attendance/Academic Progress/Performance/Behavior)Accessibility ResourcesAll of the aboveI rescind my previous authorization to release information to the individual(s) noted aboveOtherOther information to release:This authorization to release student information will be valid until rescinded or changed by the student.Insert Contact for ReleaseDo Not Release InformationDelete_ID_Do Not ReleaseDO NOT RELEASEInsert Do Not ReleaseAuthorizationIn place of your signature, please type your full legal name.eSignature*Date*Submit