AUTHORIZATION/DECLINATION FOR ACCESS TO STUDENT RECORDS
For use of t his f orm, see CC Pam 145-4, t he proponent agency is ATCC-PC
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Aut horit y
20 USC 1232g, and Public Law 93-380
Principal Purpose
To aut horize/decline t he release of any and all of f icial records maint ained by t he ROTC
Depart ment t o personnel in t he Depart ment of Def ense and/or parent s.
Rout ine Uses
To provide aut horizat ion/declinat ion t o release inf ormat ion cont ained in of f icial records.
Disclosure
Disclosure is volunt ary.
PART I - AUTHORIZATION FOR ACCESS TO STUDENT RECORDS
Having been advised of t he provisions of Public Law 93-380 (20 USC 1232g, Family Educat ional Right s and
Privacy Act of 1974) and in connect ion w it h my part icipat ion in t he Army ROTC program, I
hereby aut horize t he release of any and
(Cadet' s Name)
all of f icial records maint ained by t he
(Name of School)
or it ' s ROTC Depart ment t o personnel in t he Depart ment of Def ense and/or my parent s,
.
(Name of Parents)
I w aive any requirement t hat I be f urnished a copy of t hose records prior t o or concurrent w it h t heir
release. This consent remains ef f ect ive unt il my relat ionship w it h t he ROTC program is t erminat ed.
Signat ure of Cadet
Dat e
PART II - DECLINATION OF PARENTAL ACCESS TO STUDENT RECORDS
Alt hough inf orming my parent s of t he academic/ROTC progress made by me may assist in my quest t o
become a commissioned of f icer, I decline t o allow release of of f icial records maint ained by
ROTC Department to my
(Name of School)
parent s. (Exception: Parents w ho still claim student as a dependent for IRS purposes) If I change my mind in t he
f ut ure, I w ill inf orm t he ROTC Depart ment in w rit ing.
Signat ure of Cadet
Dat e
CC FORM 137-R, AUG 02
PREVIOUS EDITIONS ARE OBSOLETE

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