Student Name: Student ID:
THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974
(FERPA)
The Family Educational Rights and Privacy Act of 1974 prohibits Galveston College from releasing
certain student information without your written consent. As a student, you have the right to allow a
third party access to this information.
Additional information regarding FERPA and your rights under FERPA can be found in the Galveston
College Catalog.
I wish to allow the party/parties below access to my personally identifying information. I understand my rights
under FERPA and release Galveston College from all liability related to the release of the specified information
to myself or the individual(s) listed below.
I wish to allow ______________________________________________ access to the records listed below:
Any and all records/personally identifying information
Academic records (transcript, GPA, grades, progress in course(s), etc.)
Financial records (financial aid, current balance, charges on account, etc.)
Other: _________________________________________________________________________________
Student’s Signature Date
Authorization to Disclose Non-Directory
Information to a Third Party
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signature
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