Student Information Release Form

Student Information Release Form
I hereby authorise AISIT to disclose my personal information as stated in this Release Form to the Organisation/s stated below.
Student Name*
Email Address*
example@example.com
USI Number
Find Your USI: www.usi.gov.au/students/find-your-usi
Course Enrolled
NameDate of BirthAddressEmailPhoneMobile PhoneEmergency ContactEnrolment DetailsOther
I understand that my information is being released for the purposes of:*
(Provide brief explanation)
The organisation/s to which I give permission to receive my information from AISIT is/are:*
(Full name of organisation/s and contact information)
Student Signature*

Clear
Date*

DayMonthYear
Date
Privacy Statement

The personal information supplied and collected in this Form is subject to the Privacy Act 1988 (Commonwealth) and will be treated in accordance with AISIT’s Privacy Policy and Procedure. A full copy of AISIT’s Privacy Policy and Procedure is available on our website.
PP07.03 Student Information Release Form v2.0
Should be Empty: