* Required

Consent for Release of Education Records

Completion of this document authorizes the disclosure and use of education records as described below. Completion also authorizes you to discuss this information with representatives of the organization named below entitled to receive said information. If you have any questions regarding this form, please email the Director of Student Information Services, Ms. Khuloud Hajjiri Assaf at khajjiri@acsamman.edu.jo.

Student Information

Use and Disclosure Information

Please list any records you do not wish to be disclosed (choose all that apply):​​​

Delivery Options

The education records described above shall be released to the following:

Authorization and Approval

Please provide an email address where we can send a link to your current form.

Email Address :