Revised: Jun-20
Student Accessibility Services • 444 Appleyard
Drive • Tallahassee, Florida 32304
(850) 201-8430 • SAS@tcc.fl.edu
Family Educational Rights and Privacy Act (FERPA)
What is FERPA?
The Family Education Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy
of student educational records. The law applies to all schools that receive funds under an applicable program of the U.S.
Department of Education.
Student Accessibility Services Authorization for Release of Information
Records maintained in Student Accessibility Services (SAS) are covered by the Family Educational Rights
and Privacy Act (FERPA) and will be made available to you within 10 business days of a written request.
Please provide SAS with the following information:
(Please note that inaccurate or illegible information could hinder processing your request in a timely
manner.)
Student Information
Full Name (while attending TCC): ______________________________ Student ID#: __________________
Permanent Address (while attending TCC): ______________________________ City: ________________
State:_______________ Zip: ________________________
TCC Email Address: ____________________ @mymail.tcc.fl.edu
TCC Start Term – TCC End Term: Start: ____________________ End: ______________________
Current Contact Information
Name: __________________________ Contact Phone Number: _________________________
Contact Email Address: _____________________________ Fax: _______________________
Mailing Address: _________________________ City: _________________ State: _____________
Zip: _______________
I, _________________________________ hereby request a copy of my accommodations record located in
Student Accessibility Services.
SAS Application
Copies of submitted IEPs or 504 plans from other institutions
Copies of Medical or Psychiatric Records
Accommodation Letters
I would like to receive the requested record to be sent in the following way:
I will be picking up the requested documents in person at SAS at the main campus (Not available
while remote)
Emailed to contact email address
Faxed to contact fax number
Sent to third party (continue to form on page 2)
Student Signature: _____________________________________ Date:
