[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-529995-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-529995-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","authorization-to-release-personal-information","Authorization to Release Personal Information","","This document serves as an official authorization form for individuals to grant ACT Education Corp. permission to disclose their personal records and information to designated third parties. It outlines the specific conditions under which information can be released, emphasizing the requirement for written consent from the examinee. For minors under the age of eighteen, parental or legal guardian co-signature is mandatory. The form includes sections for personal identification, specify authorized recipients, and provides instructions for submission via mail, fax, or email to the ACT Test Security department. By signing, the examinee releases ACT and its agents from liability regarding the authorized disclosure of records. The document ensures that examinees maintain control over their data while facilitating the sharing of information with counselors, admissions officers, or other relevant stakeholders as needed for academic or administrative purposes.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/exam/","Exam",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/authorization-to-release-personal-information/529995/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/authorization-to-release-personal-information/529995.png","ImageObject",300,407,{"name":42,"@type":43},"anakgang17","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-10-09",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Who needs to sign this form if the examinee is under eighteen?","Question",{"text":63,"@type":64},"If the examinee is under eighteen, both the examinee and their parent or legal guardian must sign the form to authorize the release of information.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How can the completed authorization form be submitted to ACT?",{"text":68,"@type":64},"The form can be completed and returned to ACT Test Security by mail, fax, or email using the contact information provided in the document.",{"name":70,"@type":61,"acceptedAnswer":71},"Does this authorization expire?",{"text":72,"@type":64},"The authorization is effective immediately upon signing and remains in effect until the examinee revokes it in writing.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},529995,1791586271,{"code":4,"msg":82,"data":83},"success",[84,88,92,95,100,105,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":93,"slug":94},70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},7,"Healthcare",40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":96,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":33,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":30,"preview_page_count":4},962090883568,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Authorization to Release Personal Information  \nIf you are the age of eighteen or older and want us to speak with your parent, guardian, or others, you will need to complete and return the authorization form set forth below. If you are under the age of eighteen, we will speak to a parent or legal guardian; however, that person must also sign this form to permit us to speak with anyone else.  \nI,[NAME], reside at the following address:  \n.  \n\n| My date of birth is   and I consent to the release of any and all records in the possession of ACT Education Corp. (“ACT”) which are in any way related to me.\u003Cbr>ACT is authorized to release and make full disclosure of such records to, and to discuss any information relating to those records with, the following individual(s): |\n| --- |\n| [Name and title of individual to whom ACT is authorized to release information,(ex. Jane Doe, Admissions, University of X)] |\n\n[Name and title of individual to whom ACT is authorized to release information,(ex. John Doe, Counselor, ABC High School)] This authorization is effective immediately and will remain in effect until revoked by me in writing.  \nI hereby release and hold harmless ACT and its agents from any and all claims and actions based upon, arising out of, or relating in any way to any disclosure of records or information pursuant to this Authorization to Release Personal Information form.  \nA copy of this document shall serve as the original.  \nExaminee Signature:   Date:    \nIf the above-named examinee is under the age of eighteen, the parent or legal guardian of the examinee must also sign below indicating consent and agreement to this Authorization to Release Personal Information form.  \nParent or Legal  \nGuardian Signature:   Date:    \nComplete and return by mail, fax, or email to: ACT Test Security (53)  \nP.O. Box 168  \nIowa City, IA 52243-0168  \nFax: 319.341.2303  \nEmail: [test.security@act.org](test.security@act.org)","cbCaijng727K3CVV","https://ap.wps.com/l/cbCaijng727K3CVV","pdf",107647,"English","# Authorization Requirements\n## Procedures for Minors\n## Authorized Disclosure and Liability\n## Submission Instructions","[{\"question\":\"Who needs to sign this form if the examinee is under eighteen?\",\"answer\":\"If the examinee is under eighteen, both the examinee and their parent or legal guardian must sign the form to authorize the release of information.\"},{\"question\":\"How can the completed authorization form be submitted to ACT?\",\"answer\":\"The form can be completed and returned to ACT Test Security by mail, fax, or email using the contact information provided in the document.\"},{\"question\":\"Does this authorization expire?\",\"answer\":\"The authorization is effective immediately upon signing and remains in effect until the examinee revokes it in writing.\"}]","Authorization to Release Personal Information | PDF",1791522363]