Student Record of Release Authorization

I hereby apply to the North Central University Departments of Church Leadership for professional service, assistance, and aid in securing an internship position. I have indicated below my options regarding the release of information:

I grant permission for the faculty and staff of the Departments of Church Leadership to release information in my internship file to prospective churches and organizations, including website access (i.e. post application information to the website)

I agree that as an active registrant with the Departments of Church Leadership, I will keep all information concerning internship opportunities CONFIDENTIAL.

I understand that all materials received by the Departments of Church Leadership become the property of the university and are not returnable.

Name: *

Submission of this form indicates acknowledgment of and agreement to the policies, procedures, and requirements of NCU’s Internship program.

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