3RD_20 Rev. 5/22/19
Office of Financial Aid
2019–2020 STUDENT AUTHORIZATION
FOR RELEASE OF FINANCIAL AID
INFORMATION
Please complete this form using blue or black ink.
_ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ __
Last Name First Name M.I. SCC ID#
(__ ) __ _ _
Telephone Number Date of Birth
Types of record(s) to be released
Financial Aid Award(s) Verification Letter for _____________________ Aid Year.
Decline of Federal and/or State Aid for __________________________ Aid Year.
Other: ______________________________________________________________ for ________________ Aid Year.
Na
me of Individual and Agency to Release Requested Information
Name: _
Agency: _
Address: _
Street
_
City State Zip
Please Check the Appropriate Box Identifying How You Wish To Have This Information
Released
_
Mail to Third Party Hold for Pick-up
Mail to Student Fax (___ )
If you are requesting release of parent information, you must also sign this release.
_ __ _ _
Student’s Signature Date
_
Parent’s Signature Date
For Office Use Only:
Request Completed: Date:
