Fill - Free fillable FERPA Release - FERPA

TexasWoman’sUniversity

OfficeoftheRegistrar

TWUOfficeoftheRegistrarPOBox425559Denton,TX76204E‐mail:registrar@twu.eduFax:940‐898‐3097Phone:940‐898‐3036



DocType:__FERPA_______



Description:_____/_______



Forofficeuseonl



AuthorizationtoReleaseEducationalRecords



NOTICEANDINSTRUCTIONS: TheFamilyEducationRightsandPrivacyActof1974(FERPA),protectspersonallyidentifiableinformationinstudenteducation

records(suchasthestudent’sname,address,financialrecords,andgrades)fromdisclosurewithoutthestudent’ssigned,writtenconsentunlesssuchconsentisnot

requiredbylaw.Studentsarenotrequired

toauthorizedisclosureofinformationfromtheireducationrecords.ThisauthorizationformwillallowofficialsatTexas

Woman’sUniversitytoreleaseinformationspecifiedbyyoutoindividuals/organizationsidentifiedbyyouontheformwhenwrittenauthorizationisrequired.Please

fillinalloftheblanksandcheckthe

boxesthatapply.Uponcompletion,signyournameandincludethedateyousignthisauthorizationform.Returntheformto

theOfficeoftheRegistrar(ADM128)POBox425559Denton,TX76204Fax:940‐898‐3205registrar@twu.edu



AgovernmentissuedphotoIDofthestudentisrequiredwiththisform.Ifmailedorfaxed,anenlargedcopyofphoto

IDwithasignatureisrequired.



StudentInformation:

LASTNAME



FIRSTNAME STUDENTID#

CONTACTPHONE#



UNIVERSITYE‐MAILADDRESS DATEOFBIRTH



I,_______________________________ ____________,herebyvoluntarilyauthorizeTexasWoman’sUniversityofficials

PRINTNAMEOFSTUDENT

toreleasetheselectedinformationtotherecipientlistedbelowforthepurposeof____________________________



___________________________(i.e.providingaccesstoparen ts,scholarshipapplication,reimbursementfrom

employerorothersource,etc.).



Accesstostudentrecordswillonlybegrantedtotheindividual(s)listedbelow whentheyprovidetheaccesscodeyou

assign.Besuretogivetheaccesscodetotheperson(s)identifiedbelow.Theaccesscodeiscreatedbyyouonlyforthe

purposeofthisrelease,andcanbea

singlewordorphrase.AccessCode:_____________________________________



Individual(s)toreleaseinformationto: 

LASTNAME FIRSTNAME CONTACT# RELATIONSHIP



EducationalInformationtoRelease(checkone):



TypeofRecord Description



AllAcademicRecords

Includesadmission,registration,financialaid,studentaccount/billing,enrollment,grades,TSI,etc.



PartialAcademicRecords

Specifyrecordstobeshared(i.e.academic,financialaid,studentaccount/billing,housing,etc.)



 1.



 2.



 3.



 4.



Thisauthorizationisvaliduntilcanceled.Thestudentmaycancelthisreleaseatanytimebysubmittingawrittenand

signedrequesttorescindthereleaseofrecordstotheTexasWoman’sUniversityOfficeoftheRegistrar.



StudentSignature:_______________________________________________Date:______________________________







DateStampReceived



FOROFFICEUSEONLY

IDType:_______________________Verifiedby:________________________Date:________________

Fill Online, Printable, Fillable, Blank FERPA Release - FERPA_release Form

Related forms

Fillable FERPA Release - FERPA_release

Fill Online, Printable, Fillable, Blank FERPA Release - FERPA_release Form

Related forms

First 20 documents completely FREE!