Phone (254) 710-1181
FERPA Disclosure Consent Form
To release Academic Records
(Grades/GPA, Registration, Transcripts, Advising, etc.)
Please note: Such information cannot be released over the phone.
The Family Educational Rights and Privacy Act of 1974 (FERPA) was designed to protect the privacy of students’
educational records and to establish the rights of students to inspect and review their educational records. In accordance
with FERPA, as a general rule written consent of the student must be obtained before the institution may disclose the
student’s educational records to a third party.
**Typically this form must be completed and submitted in-person to the Office of the Registrar**
However, to accommodate remote form submission during COVID-19 we are temporarily accepting
completed FERPA Disclosure Consent Forms directly from students via a Baylor email account.
ALL sections must be completed.
Section A. Person(s) to whom access to education records may be provided
Name(s) of person to whom access may be provided
Section B. Duration of Release
This authorization expires
on:
Section C. Purpose of Release (check one)
□ Other (please specify):
Section D. Written Consent
This written consent is valid from the date of execution and through the time period(s) indicated
above unless the student provides written notice withdrawing his or her consent to the Office of the
Registrar.
By signing this form, I authorize Baylor University to release and disclose information from my
educational records as specified.
physical signature required
Rev. 17/10/2020
