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These information types include grades, course completion dates, postal addresses, course status, fees and payments, enrolled units and attempts, and other specified details. The form concludes with a declaration of accuracy, student signature, date, and instructions for returning the completed form to Student Central via mail or fax. Contact details for Student Central are provided, along with CRICOS and RTO provider numbers, TEQSA provider ID, ABN, and document control information. The document is designated as Controlled by Manager Student Central and was updated in September 2022.",{"@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/general/","General",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/gen119-general-authority-to-release-information/269847/",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/gen119-general-authority-to-release-information/269847.png","ImageObject",300,407,{"name":42,"@type":43},"Aurora","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-20","2026-09-15",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the purpose of the GEN119 form?","Question",{"text":63,"@type":64},"The GEN119 form is a General Authority to Release Information used by students of Charles Darwin University to authorize the university to release specific details about their academic records and course information to a third party.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What personal information is required from the student?",{"text":68,"@type":64},"The form requires the student's number, title, surname, given names, preferred name, gender, date of birth, and postal address. Contact phone numbers are also requested.",{"name":70,"@type":61,"acceptedAnswer":71},"What types of information can a student authorize the release of?",{"text":72,"@type":64},"Students can authorize the release of grades, course completion date, postal/home address, course status, fees and payments, enrolled units and attempts, or other specified information.","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},269847,1789454048,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,111,116,121,124,128],{"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":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":108,"show_sort_weight":109,"slug":110},7,"Healthcare",40,"healthcare",{"id":112,"doc_module":4,"doc_module_name":25,"category_name":113,"show_sort_weight":114,"slug":115},8,"Research & Report",30,"research-report",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":118,"show_sort_weight":119,"slug":120},9,"Religion & Spirituality",20,"religion-spirituality",{"id":119,"doc_module":4,"doc_module_name":25,"category_name":122,"show_sort_weight":119,"slug":123},"World Cup","world-cup",{"id":125,"doc_module":4,"doc_module_name":25,"category_name":126,"show_sort_weight":125,"slug":127},10,"Lifestyle","lifestyle",{"id":129,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":97,"slug":130},19,"general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":129,"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":80,"read_time":26},4810365810221,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","GEN119  \nGeneral Authority to Release Information  \nStudent Number  \nTitle  \nSurname  \nGiven Names  \nPreferred Name  \nGender  \nDate of Birth (DD MM YYYY)  \nPostal Address (must be completed by all students)  \nNumber & Street or PO Box  \nSuburb / Town  \nState  \nCountry  \n(if outside Australia)  \nHome Phone  \nWork Phone  \nMobile Phone  \nPlease indicate to whom you authorise the release of information regarding the course(s) listed below:  \n\n| Title | Surname | Given Name | Address/Email Address | Phone |\n| --- | --- | --- | --- | --- |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\nPlease indicate duration of authorisation:  \n\n| Course Name | Start date | End date | OR Duration of Course | OR Year only\u003Cbr>(eg.2019) |\n| --- | --- | --- | --- | --- |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\nCharles Darwin University requires written confirmation of any cancellation or variation to this authorisation to release information.  \nPlease indicate the type of information to be released:  \n􀁆 Grades 􀁆 Course Completion date 􀁆 Postal/Home Address 􀁆 Course Status  \n􀁆 Fees and Payments 􀁆 Enrolled units attempts 􀁆 Other:  \n\n|  |\n| --- |\n|  |\n|  |\n\nI hereby declare that the information I have entered on this form is accurate and correct.  \nStudent Signature: Date: / /  \n___________________________________________________________________________  \nPlease return this form to Student Central, Charles Darwin University, Darwin, NT 0909. Fax (08) 8946 6642. Email: [student.central@cdu.edu.au](student.central@cdu.edu.au)  \nCRICOS Provider No. 00300K (NT/VIC) | 03286A (NSW) | RTO Provider No. 0373| TEQSA Provider ID PRV12069 | ABN 54 093 513 649 | GEN119 General Authority to Release Information | Controlled by Manager Student Central | UniPrint 73390 Updated September 2022","cbCaic15EBzxr3I0","https://ap.wps.com/l/cbCaic15EBzxr3I0","pdf",163052,"English","# General Authority to Release Information\n## Student Details\n## Release Authorization\n## Information Types","[{\"question\":\"What is the purpose of the GEN119 form?\",\"answer\":\"The GEN119 form is a General Authority to Release Information used by students of Charles Darwin University to authorize the university to release specific details about their academic records and course information to a third party.\"},{\"question\":\"What personal information is required from the student?\",\"answer\":\"The form requires the student's number, title, surname, given names, preferred name, gender, date of birth, and postal address. Contact phone numbers are also requested.\"},{\"question\":\"What types of information can a student authorize the release of?\",\"answer\":\"Students can authorize the release of grades, course completion date, postal/home address, course status, fees and payments, enrolled units and attempts, or other specified information.\"}]","GEN119-General Authority to Release Information | PDF"]