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FERPA Release Form

The Family Educational Rights and Privacy Act (FERPA) affords certain rights to

students concerning the privacy of and access to their education records. This form

authorizes the educational institution named below to release education records to the

named third party; it does not obligate the institution to do so.

Student Name

Student ID

Mailing Address

Phone Number

Email Adress

The Student hereby authorizes

With a mailing address of

To release the following education records to

With a mailing address of

Check all that apply

Academic Information. Includes, but is not limited to, transcripts, credit hours enrolled/earned, grades/GPA, class schedule, academic progress, and enrollment status.

Financial Aid Information. Includes, but is not limited to, awards, application data, disbursements, eligibility, and financial aid status.

Loan Information. Includes, but is not limited to, college-maintained loan disbursements, billing and repayment history, credit reporting history, balances, and collection activity.

Student Account Information. Includes, but is not limited to, billing statements, charges, credits, payments, past due amounts, collection activity, and financial hold.

Other.

The student understands the information may be released orally or in the form of copies

of written records and understands that this form remains in effect until otherwise

FERPA Release Form

Student Name

Student ID

Mailing Address

Phone Number

Email Adress

The Student hereby authorizes

With a mailing address of

To release the following education records to

With a mailing address of

Check all that apply

Student Signature

Print Name

Date