Submitted Monday, October 6, 2025 

Important: Please read the information below before completing the form.

In compliance with the Federal Family Education Rights and Privacy Act of 1974, Capitol Technology University is prohibited from providing certain information from your student records to third parties (including parents, spouses or sponsors).  You may grant the university permission to release information contained in your student records to a third party by completing this form and submitting it to the Office of Registration and Record.  This authorization is valid until canceled in writing. 

First Name:

Last Name:

Student ID:

Daytime Phone:

Email:

I give Capitol Technology University permission to release the following categories of information (check all those that apply): 

Upon submitting this form, Capitol Technology University has your permission to release the selected information above to the following individuals. Please provide the individual's name, their relationship to you and the reason for releasing information: 

Name:

Relationship to Student:

Reason for Releasing Information: