Revised 12/2021
Authorization to Release
Student Employment Records
Under the Family Educational and Privacy Rights Act (FERPA), 20 U.S.C. 1232(g), universities and
colleges may not release information about a student's employment with the university in a
position requiring student status without the student's written consent, subject to exceptions
provided under FERPA. If you wish to provide such consent, please complete this form, sign and
date it, and return it as follows. Otherwise, check the box below if you do not have any previous
employment with a Texas state university.
I, __________________________________, authorize ________________________________
(name of university) (name of student/new employee)
at ______________________________
(city, branch, cam
pus)
to disclose informatio
n from my student employee personnel file to individuals and businesses that
request employment verification information of the type I have checked below, in order to facilitate
loan, credit, real estate, employment, transfer of state service, and similar applications that I may
have made.
I authorize release of the following types of information [check all that apply]:
Position held Disclose Do Not Disclose
Dates of employment Disclose Do Not Disclose
Salary information Disclose Do Not Disclose
If different from above, (print) name used in student employee/university personnel records:
Signature:
Date:
I do not have any previous employment with a Texas state university.