FERPA Consent to Release Educational Records

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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 blue or black ink when completing this form.

Email *

Student ID Number *

Last Name *

First Name *

Middle Initial *

Date of Birth *

YYYY

Authorized Persons: Parent/Legal Guardian, Trusted family member etc. (First and Last name) Nursing Students: If this is left blank then you are authorizing RCC to release your information. *

Code word (numbers can be included) *

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. (EX. Jimbob, Yoda, Purple)

Requirements *

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

Academic Records (Grades/GPA, registration, academic standing, class schedule, transcripts and/or enrollment information)

Financial Aid (Financial aid awards, disbursements, eligibility and/or financial aid satisfactory progress (FAFSA data - including EFC - may NOT be released)

Student Accounts (Financial records including statements, charges, credits, payments and past due amounts)

Required

Duration

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.

Grant continuous access for the duration of my academic career

I do not wish to grant continuous access. (Access will end at the end of the academic school year)

Other:

Clear selection

Student Signature-Type Full Name *

Submit

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