2019-20 Authorization of Disclosure Release Form
Student Name: UH ID#:
Phone Number: Date of Birth:
STUDENT INFORMATION
The Family Educational Rights & Privacy Act (FERPA) is a Federal law that protects the privacy of student education records, to
establish the right of students to inspect and review their education records, and to provide guidelines for the correction of
inaccurate and misleading data through informal and formal hearings.
To authorize disclosure of your financial aid information to specific individual(s) or agency(ies), please complete the release
section(s) below.
I authorize the release of my financial aid information to the following individuals:
Name: Relationship:
_____________________
Name: Relationship:
_____________________
Name: Relationship:
_____________________
Name: Relationship:
_____________________
Name: Relationship:
_____________________
Student Signature: Date:
Electronic signature or digital signature will NOT be accepted.
HAWAIʻI CC STUDENTS ONLY: 5 digit password (Example: 12345)
Note: Your password is to access Financial Aid information over the phone or in-person, without providing a state issued ID.
PARENTAL INFORMATION
I authorize the release of information to my child concerning financial documents.
Parent (Father/Mother/Stepparent) Name:
Parent Signature: Date:
Electronic signature or digital signature will NOT be accepted.
This form will remain valid until the student notifies the Financial Aid Office of any changes.
RETURN THIS FORM ALONG WITH ANY OTHER REQUIRED DOCUMENTATION TO THE COMMUNITY COLLEGE CAMPUS THAT YOU WILL BE ATTENDING:
Hawaiʻi Community College
1175 Manono Street * Hilo, HI 96720
Honolulu Community College
874 Dillingham Boulevard * Honolulu, HI 96817
Kapiʻolani Community College
4303 Diamond Head Road * Honolulu, HI 96816
3-1901 Kaumualiʻi Highway * Lihuʻe, HI 96766
Leeward Community College
96-045 Ala ʻIke Street * Pearl City, HI 96782
University of Hawaiʻi Maui College
310 West Kaʻahumanu Ave * Kahului, HI 96732
Windward Community College
45-720 Keaʻahala Road * Kāneʻohe, HI 96744
The University is committed to a policy of nondiscrimination on the basis of race, sex, gender identity and expression, age, religion, color, national origin, ancestry, citizenship,
disability, genetic information, marital status, breastfeeding, income assignment for child support, arrest and court record (except as permissible under State law), sexual orientation,
national guard absence, or status as a covered veteran. UH Title IX Coordinators' names and contact information are available at: https://www.hawaii.edu/titleix/help/coordinator/
and UH 504 Coordinators’ names and contact information are available at: https://www.hawaii.edu/offices/eeo/ada-504-coordinators/
UH HILO, UH WEST OAHU AND UH MĀNOA STUDENTS NEED TO CONTACT THEIR FINANCIAL AID OFFICE FOR CAMPUS SPECIFIC FORMS.
Rev. 04/2020
