Authorization for Release of Student Information

Federal Legislation (P.L. 93-380, the Educational Rights and Privacy Act, as amended December 31, 1974) and University regulations require that all educational units have written consent from students prior to the release of student records. In order thatwe may comply, please complete this form and return it to Career Services,University of Minnesota, Crookston.

Please check each box for items you want included in your teaching placement file or packet. The Career Center will mail out your packet every time you provide a name and address.

I hereby authorize UMC Career Services to release only the following information:

Letters of reference or recommendations that you have had individuals write and send directly to the Career Center, UMC Student Center, 2900 University Avenue, Crookston, MN 56716. Usually three letters are expected.

Your latest, updated resume which you must provide Career Services

Student Teaching Evaluations from your cooperating teachers. You must indicate each one of the four student teaching experiences that you want included. Once you have indicated that, Career Services will contact the ECE Department Coordinator for copies of the evaluations.

• Infant and Toddler Student Teaching
• Kindergarden Student Teaching
• Preprimary Student Teaching
• Primary Student Teaching

An unofficial copy of your UMC transcript. After you indicate that, Career Services will contact the ECE Department Coordinator for an unofficial academic transcript.

Other: this is where you could include a copy of your teaching license once you have obtained that from the Minnesota Department of Education.

I hereby authorize UMC Career Services to release the information checked above to the following persons or organizations:

An employer, educational institution, governmental agency or other organization requesting such information which in the judgment of the personnel of Career Services have a legitimate purpose in requesting such information.

Only those employers, educational institutions, or other persons or organizations which I specifically designate with each signed request.

Others (specify):

I further authorize UMC Career Services to continue to send the information I have specified to the persons or organizations I have specified until:
I give further notice.
Date (specify):

Signed: __________________________________________

Date: __________________________________________