Authority to Release Form

In order to best support you throughout the duration of your training and beyond, you may nominate a person and/or organisation in which a representative of KARBEN Training Solutions is able to discuss and share aspects of your student records for the purposes listed below.

This form only authorises KARBEN to provide or receive information from your nominated person or organisation about the records relating directly to the qualification or training program of which you are enrolled.

This form does not replace or negate KARBEN's legislative and regulatory reporting obligations as an RTO as outlined in the Privacy Notice and Terms and Conditions of your enrolment.

Full Name*

First NameLast Name

Date of Birth*

Date

Mobile Number*

Please enter a valid phone number.

Email Address*

Confirmation Emailexample@example.com

I authorise KARBEN Training Solutions (RTO) to release and discuss details as outlined below with the following nominated representative/s:*

Employer/ManagerSupport Worker/AgencyOther

Employer/Manager Name*

Please provide the name of your workplace and/or manager.

Support Worker/Agency Name*

Please provide the name of the agency or person who supports you.

Other*

Please provide details including name of the person or organisation.

Information we may release to or discuss with an authorised third party:

☑ Details of any transcripts, statements of attainment, certificates or testamurs (Authentication of such is required for the purposes of advanced standing / credit transfer consideration, in such cases, this form and award details will be forwarded to the issuing party / RTO for verification)

☑ Results, requests to modify training agreements, full training plans, progress results and/or assessment comments
(Such information may be requested by a third party for the purposes of (but not limited to) current or prospective training program activity or employment including traineeships and Government funded training activity and may include (but not limited to) employers, Australian Network Providers or Government authorities)

☑ Practical work placement
(This includes (but is not limited to) access to information about training / assessment progress, emergency personnel contact details and any other information that may assist with the completion of work experience or prospective employment opportunities within the organisation)

☑ Information relating to enrolment / training contract(s)
(Enrolments include traineeships, fee for service or Smart and Skilled enrolment types)

I agree*

If I wish to cancel/amend this authority to release information, I must advise the RTO of the change, in writing, as soon as practicable.I have given this authority freely and without force.

Signature*

Date completed*

Date

Form 078 | Version 25.1.0 | 01 February 2025 | Uncontrolled when printed

KARBEN Training Solutions | Registered Training Organisation (RTO) | National RTO ID 91167

Email: info@kts.edu.au | Website: www.kts.edu.au | Phone: 02 4353 7188 | Postal Address: Po Box 3380 Tuggerah NSW 2259

Authority to release information to a third party