EDU 176 2/11
Authorization to Release
Student Information
Name Student I.D.#
Address Phone Number(s)
City, State and Zip Code Date of Birth
In accordance with the Family Educational Rights and Privacy Act (FERPA), I authorize Oakland Community College to
release or disclose the information from my student record to:
Myself Third Party
Name of organization or individual receiving record
Please designate the information to release:
Conrmation of my enrollment in the college for Semester.
Include credit hours Do not include credit hours
Tuition and fees for term/year
Completion of the attached form
Other, if unrestricted, please indicate ALL
Method of release:
Mail
Address
Fax
Fax# including area code
I will pick up the information in person, showing proof of my identity.
PLEASE NOTE: If not picked up within ten (10) working days from the date of signature, requested information will be
mailed to the student address on le.
Student Signature Date
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