I_________________________________ make the following selections regarding the 

             (Printed Cadet Name)

release of my cadet disciplinary records held within the Commandant's Department:

 

SECTION 1. Disciplinary Release Selection (initial next to the desired selection)

 

 

_____ My disciplinary file may be released (If you initial this block, you must complete Section 2).

 

_____ My disciplinary file may not be released (If you initial this block, skip to Section 3).

 

 

SECTION 2. Individuals or Agencies Authorized to Receive My Disciplinary Information

 

 

1.   __________________________________________________________________________

 

2.      __________________________________________________________________________

 

3.      __________________________________________________________________________

 

4.   __________________________________________________________________________

 

 

SECTION 3.  Signature Block

 

 

________________________________                       

            (Cadet’s Signature)

 

________________________________                      

                     (Date)

 

 

 

NOTE:  THE ABOVE RELEASE IS APPLICABLE AND VALID FOR THE ENTIRE PERIOD THAT THE CADET REMAINS AT THE CITADEL, AND FOR A PERIOD OF 5 YEARS AFTER THE CADETS LEAVES THE CITADEL.  PLEASE RETURN WITH FRESHMAN REGISTRATION INFORMATION.

 

 

 

CC Form 95  (April 2003)