I give my permission to the Missouri State University-West Plains Adult Education and Literacy staff to provide information regarding my educational records to the person or agency listed below. I may add persons/agencies by writing in additional names/organizations and initialing & dating; and may revoke permission by crossing out names/organizations, initialing & dating.

Discussion may include, but is not limited to: personal contact information, attendance, employment history, classroom performance, testing information, personal and educational goals, job-related skills, and post-secondary goals/achievements.