Information Consent Form

First Name: *

Last Name: *

Phone: *

Address: *

City: *

State: *

Zip Code: *

Ohio Christian University has my consent to speak with the individual listed above concerning my:

Academic Progress: *

Yes

Student Account (Financial Aid): *

Yes

Social Progress: *

Yes

Emergency (injury or illness): *

Yes

Contractual Agreement

This consent form is valid until updated, in writing, by the student.

Digital Signature*

Digital Signature Date*