Record Release Form

Record Release Request

Loureiro maintains detailed records for all learners who participate in learning events with CEUs. Learner records are the property of Loureiro and are considered confidential. Access to the information they contain is restricted to Loureiro staff who have a legitimate reason to review information. Loureiro will release learner information only directly to the learner immediately following the learning event and at the learner’s request. To protect learner privacy, Loureiro will not release information to a third party, even at the request of the learner.

Learning Events

First Name*

Last Name*

Email*

Mailing Address*

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Address 1:

City:

Country:

State/Province:

Postal Code:

Phone Number* - -

Fax Number - -

Preferred Delivery Method*EmailMail

Last four numbers of your social security number

Signature*

By signing your full name above, you attest that all of the information entered is accurate and that you have entered it on your own behalf and did not rely on a third-party to request these transcripts.

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Training & Resources

Record Release Form

Record Release Request

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