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FERPA Consent to Release Educational Records

FERPA
Complete all sections of this form in full. Choose which records to authorize, set your access duration, and sign at the bottom. This form must be submitted in person with a picture ID, or with a Notary signature. Click Print to PDF when finished.

The Family Education Rights and Privacy Act of 1974 (FERPA) states that a student must authorize in writing the release of her or his educational records to a third party. Please print legibly in ink when completing this form.

Student Information
Enter your 7-digit employee ID number
Person(s) to whom you authorize the release of your records:

You can list multiple people. You must provide each authorized person listed with the password you choose below. If they are unable to provide the password, your records cannot be released.

Password
Password:

You are responsible for the security of this password. Protect it from unauthorized parties.

I authorize the release of educational records in the following areas (check all that apply):

Select the duration for which you authorize the release of your educational records. Granting access to the parties listed does not preclude you from revoking access to any of the parties or record types above, if done so in writing.

/ / .
Signature

I realize that if I choose to limit access no information will be shared with the people listed above after the date I select. Access can only be reinstated by completing a subsequent FERPA Consent to Release Educational Records form.

Form must be submitted in person at the office below, along with a picture ID. Otherwise a Notary signature is required.

I am not submitting my form in person. My notary verification is below.

Office Use Only
Routed to:

FERPA UPDATED 8/13/2019

When the print dialog opens, choose Save as PDF as the destination.