Consent to Release Financial Aid Information

For the purpose of determining eligibility, awarding and administering my scholarship and in support of my academic success, I hereby authorize to provide the following individuals or individual agent of an organization or scholarship provider with the following information:

• Data collected from my Free Application for Federal Student Aid (FAFSA), including tax return information disclosed under section 6103(l)(13) of the Internal Revenue Code of 1986 with respect to the applicant

• Financial Aid Information (financial aid award letters and notifications, grants, scholarships, other awards, student employment, loans, disbursements and eligibility)

• Personally Identifiable information

Name Name First Last
GCID
Must be 9 characters. Currently Entered: 1 characters.
Phone Phone - ### - ### ####
MGCCC Student Email Address
Choose the MGCCC campus or center you attend from the list below.
In the box(es) below, please list the scholarship committee or individual(s) you want the information above released.
This authorization shall be considered as a waiver of any and all of my rights and/or privileges as provided under the Family Education Rights and Privacy Act, as amended. A photocopy of this authorization shall be considered as valid as the originally signed document. This information may be used only for the stated purposes and for no other purposes.

I understand and agree that this authorization will remain in effect until I notify and in writing to revoke it:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

Consent to Release Financial Aid Information

Consent to Release Financial Aid Information

In the box(es) below, please list the scholarship committee or individual(s) you want the information above released.