Student Authorization to Use and Discard Performance Portfolio

I, Click and enter student’s name here, grant permission to the Campus Administration to keep in their records an electronic copy of my performance portfolio. I understand that the portfolio is going to be used for accreditation or educational purposes only, and that it is not going to be disclosed without my consent to other entities. I recognize that I will not be able to recover the electronic copy submitted and therefore I am keeping a copy of my performance portfolio.

By signing this document I authorize the Campus Administration to keep an electronic copy of my performance portfolio for up to 12 months and discard it at the end of this period of time.

Click and enter student’s name here. Student’s Name (print)

______Click to enter date. Student’s Signature Date

Course: Enter course number here (Ex: SPAN 101).

Term: Choose course Part of Term. Facilitator : Enter course facilitator name here.