Student Search Service Third Party Use Request Form

STUDENT SEARCH SERVICE – THIRD PARTY USE REQUEST FORM

[Please complete all areas in red]

1.  I, NameofStudentSearchServiceUser, hereby request the College Board’s consent to allow ThirdPartyOrganizationName, to have access to the Student Search Service data licensed by my institution/organization beginning on StartDate.

2.  ThirdPartyOrganizationName will use the data for the following purpose:

Insert how the data will be used by the third party – please be specific

3.  Should the College Board grant consent for the third party referenced herein to use the Student Search Service data, prior to providing such data to the third party, I agree to have the third party sign the Student Search Service Third Party Data Use Agreement and to immediately provide a copy of such agreement to the College Board when fully-executed. I understand that I am required to notify the College Board immediately should my institution/organization terminate the relationship with ThirdPartyOrganizationName at any time after consent is granted.

NAMEofINSTITUTION

By: / IndividualName
Print Name:
Email Address:
Title:
Date:

As a reminder, please read and review our Student Search Service Authorized Usage Policies, found here: http://media.collegeboard.com/mSSS/media/pdf/sss-authorized-usage-policies.pdf

Any violation of the Authorized Usage Policy or the Student Search Service Agreement may result in revocation of access to Student Search Service:

Users must include in all Student Search Service communications a statement identifying The College Board’s Student Search Service as their list source. Our research indicates higher response rates to mailings that identify Student Search Service by name than those that do not. Users must also offer recipients a quick and simple method for opting-out of future communications.

Please return this form to The College Board’s Student Search Service

• Email: • Fax: (703) 842-8795