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I hereby authorize Alexandria Technical and ³ÉÈËÖ±²¥ to release and/or orally discuss the education records described below about me to: (list names of both parents, guardians, others)

I understand that the student records information listed above includes information about me which is classified as private under Minn. Stat. §13.32 and the Federal Family Education Rights and Privacy Act. I understand that by signing this Informed Consent Form, I am authorizing Alexandria Technical and ³ÉÈËÖ±²¥ to release to the persons named above and their representatives information which would otherwise be private and not accessible to them.

I understand that, at my request, Alexandria Technical and ³ÉÈËÖ±²¥ must provide me with a copy of any educational records it releases to the persons named above pursuant to this consent. I understand that I am not legally obligated to provide this information and that I may revoke this consent at any time. This consent expires one year from the date signed or until I withdraw my consent, whichever comes first. A photocopy of this authorization form may be used in the same manner and with the same effect as the original document.

I am giving this consent freely and voluntarily and I understand the consequences of my giving this consent.