Information contained in your student education record is confidential and protected by the Family Educational Rights and Pri
Sandhills Community College, or an agent thereof, will not release information pertaining to your education record, other than that deemed directory
information, without your prior written authorization. Such authorization to release information from your education records to another person(s)
or organization(s) may be designated below.
SECTION I – STUDENT AUTHORIZATION TO RELEASE EDUCATION INFORMATION
Student’s Last
Name
Student’s
First Name
Middle
Name/Initial
Student’s
SCC ID Number
Student’s
Date of Birth
(DOB)
Effective
Term and
Year
FA 2019 - SU 2020
I understand that this authorization to release
information will remain in effect for the above
Purpose of Disclosure
(check all that apply):
☐ Family Communications
☐ Employment
☐ Admission to Educational Institution
☐ Other (specify): ___________________________________________________________
I authorize Sandhills Community College to release the following information from my educational record:
Academic Info Financial Aid/Veterans Benefits Student Account Info
☐
☐ Grades ☐ Awards/Benefits/Loans ☐ Billing activity ☐ Other (specify): ____________________________
☐ GPA ☐ Application Data ☐ Charges _________________________________________
☐ Enrollment status ☐ Disbursements ☐ Credits _________________________________________
☐ Registration ☐ Eligibility ☐ Payments _________________________________________
☐
Balances _________________________________________
I authorize Sandhills Community College to release the information from my educational record noted above to the following person(s) or organization(s):
Phone Number
Relationship:
Last 4 Digits
of SSN:
DOB
Phone Number
Relationship:
Last 4 Digits
of SSN:
DOB
Family Educational Rights and Privacy Act (FERPA)
RELEASE FORM
Student must submit this form through their SCC
student email account.
