T: +1 671.735.2940/2945 F: +1 671.734.2907 W: www.uog.edu
Mailing Address: 303 University Drive UOG Station Mangilao, Guam 96923
The University of Guam is a U.S. Land Grant Institution accredited by the Western Association of Schools and Colleges
Senior College and University Commission and is an equal opportunity provider and employer.
ADMINISTRATION & FINANCE
Bursar Office
FAMILY EDUCATIONAL RIGHTS AND PRIVACY
ACT
PERMISSION
TO
RELEASE INFORMATION
In compliance with the Federal Family Educational Rights and Privacy Act of 1974 (FERPA) as
amended,
information
about your student fee account may NOT be released
to
a third party (i.e.
your
parents,
spouse, sponsor, etc.)
without
your written permission.
I,
with SS
N
:
authorize the release of information on my student account(s) with the Bursar Office at the
University of Guam to the individual(s) listed below. This
permission
is
valid
until
_____________________________________(expected date of graduation).
do not authorize release of my student fee account
information
to a third party.
To
grant
specific
individuals
access
t
o
your
student
account
information,
please
complete
the following:
Name:
Relationship:
SSN:
Home #:
Address:
Work #:
Other #:
Employer:
_______________
Name:
Relationship:
SSN:
Home #:
Address:
Work #:
Other #:
Employer:
_______________
PLEASE NOTE: THIS
AUTHORIZATION
PERTAINS TO STUDENT
FEE
ACCOUNT INQUIRIES
ONLY. Requests for
information maintained
by other offices (i.e. Office of Admissions & Records,
Financial Aid Office, Housing etc.) are not covered by this authorization.
Student Sign
ature:
Date: __________________