Registrar’s Office
Consent for the Disclosure of
Education Records
This form must be signed and submitted by the student in person; it cannot be faxed or emailed.The Registrar’s Office is located in SSC L157.
First Name MI Last Name Banner ID Number
I hereby authorize Manchester Community College and its employees to release the following information (please specify):
This release is authorized for the following individuals and/or organizations:
Name of Person/Organization Relationship to Student
Name of Person/Organization Relationship to Student
Name of Person/Organization Relationship to Student
Name of Person/Organization Relationship to Student
Disclosure is made for the following purpose(s):
I acknowledge and authorize that photocopies and facsimiles of the original of this Consent for the Disclosure of Education Records, including my signature, shall be
as valid as the original.
Student Signature Date
KNOW WHAT YOU ARE SIGNING
The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student education records. The law applies to all schools that receive
funds from the U.S. Department of Education. Schools must have written permission from the student in order to release any information from a student’s education
record. Students may use the Consent for the Disclosure of Education Records form if they would like to authorize the college to release their eduaction records
information to someone other than the student.
October 2018/PR
Date Received _______/_______/__________ Reviewed By ______________________________
