Tel: 866-522-7747-2026

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  1. Click ‘Get Form’ to open the Third-Party Authorization Form in the editor.
  2. Begin by entering your Student Name and Purdue Global Student ID or the last four digits of your SSN in the designated fields.
  3. Provide your email address and, if desired, the name of your Student Support Specialist.
  4. In the 'Reason for Release of Information' section, clearly state why you are granting access.
  5. List the individuals you wish to authorize by entering their first and last names. Indicate their relationship to you.
  6. For each individual listed, place an X in one of the columns to either grant or withdraw permission for them to access your records.
  7. Select the type of records you wish to share by checking only one option: ALL RECORDS, ACADEMIC RECORDS ONLY, or FINANCIAL RECORDS ONLY.
  8. Specify an expiration date for this authorization in the provided field.
  9. Finally, electronically initial and sign where required. Click ‘Finish’ to submit your completed form.

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2016 4.3 Satisfied (20 Votes)
2013 4 Satisfied (26 Votes)
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