Fillable 2019-2020 Consent To Release Form Fillable

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2019-2020 Consent To Release Form Fillable

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2019-2020 Consent to Release CNSRL
Financial Aid and Veterans Services
The Family Educational Rights and Privacy Act (FERPA) of 1974 is designed to protect the privacy of
a student’s educational records. These confidential records include financial aid, scholarship, and
student account information, and will not be released without written consent from the student. By
signing this form, the student authorizes MSJC personnel to release confidential financial aid
information to a designated person(s).
Person to Release Information To:
Full Name: ___________________________
Relationship to Student: ___________________________
Driver’s License #: ___________________________
Date of Birth: ___________________________
I understand the person listed on this form must confirm his/her identity in person to
have access to my information. This authority does not include the ability to change or
update information on my student file.
The following information may or may not be disclosed as indicated below:
Disclose
Not to Disclose
□
□ Financial Aid Holds
□
□ Financial Aid Disbursement
□
□ Financial Aid Application Status
□
□ Satisfactory Academic Progress (SAP)
□
□ Statement of Responsibility Status
□
□ Veteran Standards of Progress
_____________________________________________ _________________
Student’s Signature Date
*Expires: June 30, 2020
This document must be completed and turned in at the Financial Aid office with proper
identification by the student. Please attach a photocopy of a government issued ID of the
person to release information to. Forms will not be accepted by anyone other than the
student.
_____________________________________________________________________________________________
For Office Use Only
Staff Initials: ___________ Date Entered: _________
2019-2020 CONSENT TO RELEASE
STUDENT INFORMATION
Please PRINT clearly with black/blue ink
Last Name
First Name
Student ID Number
SJC Financial Aid Office * 1499 N State Street * San Jacinto, CA 92583 * Telephone: (951) 487-3245
MVC Financial Aid Office * 28237 La Piedra Road * Menifee, CA 92584 * Telephone: (951) 639-5245
Email: finaid@msjc.edu * Website: www.msjc.edu
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2019-2020 Consent To Release Form Fillable

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Completed 5 November 2019

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