FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT
The Family Educational Rights and Privacy Act (FERPA), otherwise known as the Buckley Amendment, provides that
there are certain rights of the student to have access to educational records.
We have provided this form so that the STUDENT may authorize persons other than him/herself to personally,
telephonically, or electronically make inquiries and receive information about Admission/Registrar’s & Billing
pertaining to the student. Additionally, the STUDENT must provide the information requested below if the student
wishes to make telephonic or electronic inquiries and receive individualized information.
This code will be entered into the student records system and will be used to allow or restrict access until the
STUDENT either rescinds the authorization in writing to the Admissions/Registrar's office or provides a new access
code which will immediately replace the one in force. If a FERPA codes is not on file, we will not be able to discuss
student records information with anyone unless the student is present and allows access.
The student must write any combination of five (5) numbers in the following blocks, sign and date this form, and
return it to the Admissions/Registrar’s Office. To increase security the number should not be sequential (eg. 12345) or
repeating (eg. 11111).
By signing this form, I understand that whomever I share my personal FERPA number with
has access to my student educational records and may make changes/additions/deletions to
my record. Student educational records may include admission, registration, financial aid,
billing, and transcript information, as well as other student information. I also understand
that I may change my personal FERPA number at anytime by submitting a new form to the
Date of Birth: ID#: ____________________
A COPY OF A STATE OR FEDERAL PHOTO ID
MUST BE SUBMITTED WITH THIS FORM.
Bossier Parish Community College is accredited by the Southern Association of Colleges and Schools Commission on Colleges to award associate degrees, diplomas, and certificates. Contact the
Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Bossier Parish Community College. • Bossier Parish
Community College does not discriminate on the basis of race, color, national origin, gender, age, religion, qualified disability, marital status, veteran's status, or sexual orientation in
admission to its programs, services, or activities, in access to them, in treatment of individuals, or in any aspect of its operations. Bossier Parish Community College does not discriminate in its
hiring or employment practices. • Coordinator for Section 504 and ADA: Angie Cao, Student and Disability Services Specialist - Disability Services, F254, 6220 East Texas Street, Bossier City, LA
71111 - (318) 678-6511 - email@example.com. - 8:00 a.m.–4:30 p.m. M-F, excluding holidays and weekends. • Equity/Compliance Coordinator: Teri Bashara, Director of Human Resources - Human
Resources Office, 6220 East Texas Street, Bossier City, LA 71111 - (318) 678-6056 - 8:00 a.m.–4:30 p.m. M-F, excluding holidays and weekends.
Revised May 2019
click to sign
click to edit