Consent to access student information

Consent to access student information

This form is to be used to authorise a person or organisation to have access to your student information. You will be required to nominate the name of the other party, the start and end date of the authority and the type of information that can be released. We will only share the information that you nominate on this form with the authorised party.

By completing this form you acknowledge that:
a) The information you have provided is correct
b) The authorised person / organisation must verify their details with UOW staff if accessing your record, including where appropriate their identity.
c) If collecting documents on your behalf, the authorised person must provide photo ID to AskUOW at the time of collection to enable verification of their identity (e.g. driver’s license, passport)
d) AskUOW will not release items or information unless satisfied with the identity of the authorised person or organisation on this form
e) UOW accepts no responsibility for items once they have been collected by your authorised person or organisation
f) You understand you should only allow someone you trust to collect items on your behalf and
g) The information you provide on this from will allow the authorised person/organisation to access the type of information you have nominated on this form your UOW record and/or collect items on your behalf during the period you specify.

UOW is committed to protecting your privacy. As outlined above the information collected on this form is for the purpose of verifying and authorising access to your student information. We will handle your personal information in accordance with UOW’s legislative obligations. Your information will be stored securely and only used or disclosed as necessary to fulfill the purpose of this form or as required by law.

Further information regarding UOW’s commitment to privacy can be found at https://www.uow.edu.au/privacy/.

Please note you have the right to withdraw your consent or make changes to this form at anytime, please contact AskUOW on +61 2 4221 3927 or at askuow@uow.edu.au.

Today's date Today's date / DD / MM YYYY
UOW student number
UOW username
Student name Student name First Last
Date of birth Date of birth / DD / MM YYYY
[HIDDEN] Reference number (if applicable)
UOW email address
Personal email address
Phone
Degree/Course
Authority
I wish to ...

I wish to ... Authorise a person Authorise an organisation
Consent

I authorise UOW to release my personal information to the below person/organisation:
Name of person Name of person First Last
Name of authorised organisation
Authorised person's date of birth Authorised person's date of birth / DD / MM YYYY
Authorised person's phone number
Authorised person's email address
Authorised person's residential address as per ID Authorised person's residential address as per ID
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Authorised organisation's address Authorised organisation's address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Authorised organisation's email
Authorisation start date Authorisation start date / DD / MM YYYY
Authorisation end date Authorisation end date / DD / MM YYYY
Select the information that you authorise UOW to release to authorised person - tick all applicable boxes:

Select the information that you authorise UOW to release to authorised person - tick all applicable boxes: Course details (e.g. name of course, campus, status) Dates of attendance Date of conferral/graduation Enrolment advice (e.g. subject selection, how to apply, withheld records) Fee information and payment of fees Subjects studied Subject results Updating personal details (e.g. change of name, USI errors, contact information) Other
Select the information you authorise UOW to release to authorised organisation - tick all applicable boxes:

Select the information you authorise UOW to release to authorised organisation - tick all applicable boxes: Confirmation of personal details (e.g. DOB, former name) Course details (name of course, campus, status) Dates of attendance and study load (e.g. full time or part time) Date of completion and conferral/graduation Subjects studied and credit/advanced standing Subject results and awards received Other
Select the documents which can be collected - tick all the applicable boxes

Select the documents which can be collected - tick all the applicable boxes Completion letter Course Details letter Enrolment Record Enrolment Status letter Fee Statement Testamur Transcript
Other information that I authorise UOW to release:
Signature of consentee (please 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.
Authorisation

By signing and submitting this form, you are confirming you are the UOW student specified in this form and have the authority to permit UOW to release the stipulated information in your student record.