LSU Eunice | P.O. Box 1129 | Eunice, LA 70535 | www.lsue.edu | Phone: 337-550-1302 | Fax: 337-550-1266
Authorization to Release Academic Records*
Office of the Registrar
Louisiana State University Eunice
P.O. Box 1129 • Eunice, LA 70535
Student Authorizing Release of Records:
Name of Student (Last, First, Middle Initial):
FERPA
The Family Educational Rights and Privacy Act (FERPA) of 1974 establishes the rights of students
with regard to education records. The act makes provision for inspection, review and amendment
of educational records by the students and requires, in most instances, prior consent from the
student for disclosure of such records to third parties. The consent must be in writing, signed and
dated by the student and must specify records to be released, reason for release, and the names
of the parties to whom such records shall be released. The act applies to all persons formerly and
currently enrolled at an educational institution. Access to educational records does not give
permission to make changes to the student’s record.
For more information, visit: http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html
Check All that Apply:
____ I hereby give permission for LSU Eunice personnel to provide information concerning my
academic transcript to the person(s) identified below.
____ I hereby give permission for LSU Eunice personnel to provide information concerning my
academic advising notes to the person(s) identified below.
____ I hereby give permission for LSU Eunice faculty, at their discretion, to provide information
concerning my in class performance and grades to the person(s) identified below.
Check One:
____ This waiver will be in effect as long as I am a student at LSU Eunice.
____ This waiver will be in effect from: (Date) ________ until: (Date) _________
