Student Consent for Release of Records

DigiPen Institute of Technology Singapore will not release any information pertaining to a student’s academic, financial, or account records to any family member or person who may request information about an individual’s record, unless permission to release this information is indicated by the student through completing and turning in the Student Consent for Release of Records form.

Full Name (as in NRIC/FIN/Passport) *
DigiPen email address *
SIT ID *
Start Date of Record Release Start Date of Record Release * / DD / MM YYYY
Please indicate the information you allow DigiPen (Singapore) to release: *

Please indicate the information you allow DigiPen (Singapore) to release: Academic information - Academic information includes: all grades, how many credits are being taken and directory information regarding a student’s instructors and academic advisor. Even if this release is given, DigiPen (Singapore) does NOT mail grades to selected individuals. Financial Account Information - Financial account information includes: the amount of loans, scholarships awarded and the ability to inquire about the student’s account balance and pay the student’s bills. Any other records (class absences, CCA etc) Other Other
DigiPen (Singapore) may release information as selected above to the following individual(s) upon request. This authorization shall be in effect until the student provides written revocation to the Registrar’s Office.

1) Name DigiPen (Singapore) may release information as selected above to the following individual(s) upon request. This authorization shall be in effect until the student provides written revocation to the Registrar’s Office.

1) Name * First Last
Relationship *
Phone
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
2) Name 2) Name First Last
This is the description of your section break.
Relationship
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.