Parent Authorization

Parental Release for Release of Information

Parent’s Name(s):*

First NameLast Name

I/We are are the parent’s/guardian of

First NameLast Name

Date of Birth

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I/We authorize Jessica Applestone/Applestone Admissions Consultants (AAC) to receive and/or release confidential information including but not limited to: academic records, transcripts, psychological testing, behavioral and progress reports.

I also give my permission for telephone or email exchanges between my child’s school and AAC. I understand that all information shared will be kept strictly confidential and used only for the purpose of providing the requested academic consulting services.

Signature

Date