Fillable CONSENT TO RELEASE 2020-2021 Financial Aid and Veterans (Mt. San Jacinto Community College District)

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CONSENT TO RELEASE 2020-2021 Financial Aid and Veterans (Mt. San Jacinto Community College District)

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2020-2021 Consent to Release
CNSRL
Financial Aid and Veterans Services
The Family Educational Rights and Privacy Act (FERPA) of 1974 is designed to protect the privacy of a student’s
educational records. These confidential records include financial aid, scholarship, and student account information, and
will not be released without written consent from the student. By signing this form, the student authorizes MSJC personnel
to release confidential financial aid information to a designated person(s).
Person to Release Information To:
Full Name: ___________________________
Relationship to Student: ___________________________
Driver’s License #: ___________________________
Date of Birth: ___________________________
I understand the person listed on this form must confirm his/her identity in person to
have access to my information. This authority does not include the ability to change or
update information on my student file.
The following information may or may not be disclosed as indicated below:
Disclose
Not to Disclose
□
□ Financial Aid Holds
□
□ Financial Aid Disbursement
□
□ Financial Aid Application Status
□
□ Satisfactory Academic Progress (SAP)
□
□ Statement of Responsibility Status
□
□ Veteran Standards of Progress
□ I wish to rescind my 2020-2021 Consent to Release for: __________________________
______________________
_________________________________________________
Student’s Signature
Date
*Form expires on
June 30, 2021
This document must be completed and turned in to the Financial Aid office via emai
l
by the student. Please attach a
photocopy of a government issued ID of the person to release information to. The student must provide a photocopy of their
MSJC Student ID or a government issued ID.
_____________________________________________________________________________________________
For Office Use Only
Staff Initials: ___________ Date Entered: _________
2020-2021
CONSENT TO RELEASE
STUDENT INFORMATION
Please PRINT clearly with black/blue ink
Last Name
First Name
M.I
Student ID Number
Website: https://msjc.edu/financialaid/
Virtual Lobby: https://msjc.edu/hub/
Telephone: (951) 487-3245
P R I N T
C L E A R
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CONSENT TO RELEASE 2020-2021 Financial Aid and Veterans (Mt. San Jacinto Community College District)

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Completed 5 September 2020

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