Admissions & Records
Privacy Consent Form
As a student, you have the right to keep your education records private. The Family Educational Rights and Privacy Act
of 1974 (or FERPA) protects the privacy of education records of all students. Under Section 49061 of the Education
Code, parents of community college students do not have a right to access to their children’s student records,
regardless of whether the student is under the age of 18. The RCC Admissions and Records department honors your
privacy. If you choose to give any information to a person or agency, you may fill out this form to process your request.
For Admissions and Records office use only. A copy of the student’s Photo Identification must be attached to this form for
the requested information to be released.
Student Information:
Student Name:
Last Name First Name Middle Initial
Student ID: Date of Birth: _________ ________ ________
Month Day Year
As a student of Riverside City College, I give
Print Your Name Authorized Designee
permission to request/receive the following:
[ ] TRANSCRIPTS
[ ] ENROLLMENT VERIFICATION
[ ] PAYMENT RECEIPT (Includes class schedule)
[ ] HIGH SCHOOL DUAL ENROLLMENT TRANSACTION or INFORMATION
[ ] INTERNATIONAL APPLICATION PROCESSING
By signing this form and providing a copy of my identification, I understand and approve the release of
my information to the above named authorized designee. I also understand that this documentation is
valid for this occurrence only.
Student Signature: Date:
Student’s Authorized Designee:
I confirm that I am only requesting this information as the designee of the above named Riverside City College student.
Furthermore, I understand that in order for this request to be processed I must have my photo I.D. present and that I
will only be allowed this information once.
Authorized Designee’s Name (Please Print):
Authorized Designee’s Signature: Date:
12/03/19 RM
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