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2020-21 Authorization of Disclosure Release Form
UH ID#:%
Date of Birth:
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%
inaccurat e %an d %misleading %da ta %th ro u g h %in fo rmal%and %form a l%h e a rin gs .
To authorize disclosure of your financial aid information% to% specific individual(s) or agency(ies), please complete the release
section(s) belo
w.
I"authorize "t h e "re le a se "o f "my "financial"aid "informa tio n "to "the "follow in g "in d iv idu a ls :
Name:
Relationship:
Relationship:
Relationship:
Relationship:
Relationship:
Student Signature: Dat
e:
H
AWAIʻI& CC& STUDENTS ONLY:&5 &digit &passw o rd &( E xa mple:&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 "t h e "re le a se "o f "in f o rmation "to "my "ch ild "c o n ce rn in g "f in a n cia l" documen ts.
Parent (Father/Mother/Stepparent) Nam
e:
Parent Signature: Dat
e:
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 *% H ilo, HI 96720
Honolulu Community College
874% Dillingham Boulevard *% Honolulu, HI 96817
Kapiʻolani Community College
4303% Diamond Head Road *% Honolulu, HI 96816
3-1901% Kaum ualiʻi 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, %ance stry, %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% cont
act 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. 10/2019
Name:
Name:
Name:
Name:
Student Name:
Phone Number:
STUDENT INFORMATION
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