Subject to certain exceptions (known as directory information) set forth in the Federal Family Education Rights and Privacy Act (FERPA) of 1974, Feather
will not provide personally identifiable student information to third parties without the student’s signed, written permission. This
information includes, but is not limited to:
registration, student financial records, assessments, financial aid, and other student records.
Notice: this student information release form remains in effect for one academic year (July 1, 2019 – June 30, 2020)
You, the student, may grant Feather River College permission to release authorized information to a third party by submitting this completed form. Third
but are not limited to: parents, spouses and third-party sponsors. A separate form must be submitted for
you wish to grant access to your
information. Authorized information will be provided only upon request by, and proof of identity of, the third party.
Print Student Information
FRC ID Number:
First M.I. Last
Current Mailing Address City State Zip Current Phone Number
Print Third Party Designee: PERSON (parent, relative, spouse, etc.)
Name Relationship to Student
Address (City, State, Zip) Birthdate Last 4 Digits of SSN
Print Third Party Designee: AGENCY (scholarship donor, employer, etc.)
Address (City, State, Zip) Phone Number
Information Types Allowed (Check one or more of the boxes below to grant authorization):
Registration, academic performance/standing, class schedule, transcripts and/or enrollment information, degree, grade point average, housing (
Financial aid awards, application data, disbursements, eligibility and/or financial aid satisfactory academic progress (
Finance-related records, including billing statements, charges, credits, payments and past-due amounts (
All Veterans Education Benefits Information (
Housing & Homeless Services/Foster, Homeless & Transitional Youth Services (
Incomplete, incorrect, unsigned or undated forms will not be accepted and will be returned to the student.
By submitting this form, you
giving the third party authorization to speak, act, or sign any documents on your behalf. If you are
contacted by phone by any college
department, the college reserves the right to speak only to you and no one else.
By signing below, I consent to the release of the personal student information specified above to the individual or agency listed.
Student’s Signature: _______________________________________________________ Date: _____________________
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.