Family Authority Form – Personal information in school records
Use this form to authorise the NSW Department of Education to release the personal information of multiple
people in your family under the
Government Information (Public Access) Act 2009 (GIPA Act).
School and counselling records of a student often contain references to other members of the student’s family,
including references to parents’ or siblings’ names, addresses, contact numbers, health or other personal
information provided to school. Examples include: Family details provided in enrolment forms, family history
provided to school to support student’s wellbeing, correspondence to and from the school by the parents.
The personal information of any family member for whom authority is not granted wil be redacted from any
records released to you.
I, ……….………………………………….………….., authorise the Department of Education to release any
(Print ful name)
personal information relating to myself and the children/adults listed below concerning the attached access
application under the GIPA Act to
Myself / Lawyer / Partner / Agent.
(Select)
I authorise the disclosure of personal information for these children:
•
………………………………………………….
(Name of subject of application),
•
………………………………………………….
(Name of any other children),
•
………………………………………………….
(Name of any other children).
Adult family members (including the subject of the application) can authorise the disclosure of their personal
information relevant to this GIPA Act by signing below and attaching a copy of their ID.
•
….………………………………… ………………………………… …………………………………, and
(Print ful name)
(Relationship to authorised receiver)
(Signed by other adult)
•
….………………………………… ………………………………… ………………………………….
(Print ful name)
(Relationship to authorised receiver)
(Signed by other adult)
Name of
Lawyer / Partner / Agent to whom documents are to be provided:
……………………………………………………………………………………………………………………………….
(Please print ful name or law firm name)
☐
Relevant proof of relationship documents has been attached.
(See next page)
☐
Relevant identification documents have been attached.
(See next page)
I declare that the information I have provided on this form is true and correct.
Signed: ……………………………………….………….
Date: ………………………..
Print name: ……………………………………………..
Privacy Notice The information you provide on this application form is needed to process your GIPA application.
It is a legal requirement for you to give us this information. It wil be stored securely. If you do not provide the required information it
could mean that your application is delayed or cannot be processed.
NSW Department of Education – Right to Access – Legal Services
Level 5, 105 Phil ip Street, Parramatta NSW 2150 GPO Box 33 Sydney NSW 2001 T 7814 3525
E xxxx@xxx.xxx.xxx.xx
REQUIRED DOCUMENTATION
When requesting records of a
student under 12 years of age
☐ ID of student (e.g. passport, school ID card, proof of age card, or learner/driver licence)
☐ ID of parent/guardian making the application (e.g. driver licence, passport, other)
☐ Proof of parent/guardian relationship with student whose information is requested, and, if
applicable, any other children listed in the ‘Family Authority Form’ (e.g. Medicare card, benefit
card, birth certificate)
☐ ID of any other adult family members listed in the ‘Family Authority Form’ who authorise
release of their personal information.
When requesting records of a
student between 12-18 years of age
☐ ID of student (e.g. passport, school ID card, proof of age card, or learner/driver licence)
☐ ID of parent/guardian making the application (e.g. driver licence, passport, other)
☐ Proof of parent/guardian relationship with student whose information is requested, and, if
applicable, any other children listed in the ‘Family Authority Form’ (e.g. Medicare card, benefit
card, birth certificate)
☐ ID of any other adult family members listed in the ‘Family Authority Form’ who authorise
release of their personal information.
☐
If you are requesting the
counselling files of a student who is over the age of 12, a ‘Student
Authority Form’ signed by student whose counselling records are being requested is also
required.
When requesting records of a
student who is over 18 years of age
☐ ID of student (e.g. passport, driver licence, other)
☐ ‘Student Authority Form’ signed by the student
☐ ID of parent/guardian making the application (e.g. driver licence, passport, other)
☐ Proof of parent/guardian relationship with student whose information is requested, and, if
applicable, any other children listed in the ‘Family Authority Form’ (e.g. Medicare card, benefit
card, birth certificate)
☐ ID of any other adult family members listed in the ‘Family Authority Form’ who authorise
release of their personal information.
Lawyers / Agents
☐ ‘Family Authority Form’ or other written authority signed by the client and which summarises
the specific records/information to be provided to the lawyer.
☐ ID and Proof of Relationship documents as outlined above for relevant age groups.
NSW Department of Education – Right to Access – Legal Services
Level 5, 105 Phil ip Street, Parramatta NSW 2150 GPO Box 33 Sydney NSW 2001 T 7814 3525
E xxxx@xxx.xxx.xxx.xx
Student Authority Form
This form supplements the Family Authority Form and should be used when a parent/guardian or their
lawyers are requesting the counselling records of a student over 12, or when requesting any records of a
child who is over 18 under the
Government Information (Public Access) Act 2009 (GIPA Act).
Student counselling files may contain sensitive disclosures made in confidence and the department considers
that students over 12 years of age is old enough to decide whether their parents should have access to this
information, unless they lack capacity.
Students over 18 are adults and must directly authorise access to their records, unless they lack capacity.
I, ……….………………………………….………….., authorise the Department of Education to release my
(Print full name)
personal information as contained in any school or counselling records, or any other records requested in the
GIPA Act application, to my
Parent / Guardian / Lawyer / Agent.
(Select)
Name of
Parent / Guardian / Lawyer / Agent to whom documents are to be provided:
……………………………………………………………………………………………………………………………….
(Please print ful name or law firm name)
Signed: ……………………………………….………….
Date: ………………………..
Print name: ……………………………………………..
Privacy Notice The information you provide on this application form is needed to process your GIPA application.
It is a legal requirement for you to give us this information. It will be stored securely. If you do not provide the required information it
could mean that your application is delayed or cannot be processed.
NSW Department of Education – Right to Access – Legal Services
Level 5, 105 Phil ip Street, Parramatta NSW 2150 GPO Box 33 Sydney NSW 2001 T 7814 3525
E xxxx@xxx.xxx.xxx.xx