AUTHORIZATION FOR RELEASE OF DISCIPLINARY INFORMATION
I_________________________________ make the following
selections regarding the
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 (You must list Parent(s) name(s) if you want
disciplinary information released to one or both)
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
4. ______________________________________________________
SECTION 3. Signature Block
________________________________
________________________________
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 CADET LEAVES THE CITADEL. PLEASE RETURN IN ENCLOSED ENVELOPE.
CC Form 95 (May 2003)
