INFORMATION RELEASE FORM

UOW College Australia

Student Number
Title
Family Name
First Name
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Contact Phone
Course (if required)
Please indicate:

Please indicate: Over 18 years of age Under 18 years of age
CONSENT
I give consent to UOW College to release the following information to the following person(s).
I give permission for the College to disclose information related to my enrolment/study at UOW College to (tick the relevant boxes):

I give permission for the College to disclose information related to my enrolment/study at UOW College to (tick the relevant boxes): Parent Agent UOW/UOWC Ltd Staff Other (if other, please specify who in the box below)
Other information
Please specify e.g. medical problems, personal problems, financial (debts), accommodation, study problems, behavior problems, social problems
NO CONSENT
I do NOT give consent to the UOW College to release any information about me.
The information collected in this form is subject to the Privacy Act 1988 (Cth) and will be treated in accordance with UOW College’s Privacy Policy. A copy of the UOW College Privacy Policy is available at www.uowcollege.edu.au/support-resources/policies-procedures/

Please sign below to indicate that you have read and understood UOW College’s Privacy Policy and that you consent to UOW College collecting, storing, using and disclosing your personal data in accordance with the conditions contained therein.
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.
Date Date / DD / MM YYYY

INFORMATION RELEASE FORM

INFORMATION RELEASE FORM

CONSENT

NO CONSENT