Release of Student Information Form

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The Family Education Rights & Privacy Act (FERPA) is a federal law which influences record keeping in most colleges and universities. It is popularly known as the 鈥淏uckley Amendment鈥�. The law requires that the educational records of students in colleges and universities receiving Department of Education funds remain confidential. The Buckley Amendment allows others to access a student鈥檚 educational records only if the student consents.
I,*
Name of Student
Student ID
Email*
authorize the appropriate staff of 91吃瓜网 to discuss the following information with the following person(s).
Check All Areas That Apply*
- Grades
- General Academic Progress
- Finances/Billing Information
- Financial Aid Information
May be discussed with the following:*
Name Relationship
I understand that this release of information does NOT allow access to the Student Information System (Student Records via the Internet) or Official Transcripts.

This authorization shall continue indefinitely or until the student named above notifies the Registrar鈥檚 Office otherwise in writing.
Student Signature*
Date*
MM slash DD slash YYYY

Date

897

Students enrolled fall 2019

Name	Relationship