TexasWoman’sUniversity
OfficeoftheRegistrar
TWUOfficeoftheRegistrarPOBox425559Denton,TX76204Email:registrar@twu.eduFax:9408983097Phone:9408983036
DocType:__FERPA_______
Description:_____/_______
Forofficeuseonl
y
AuthorizationtoReleaseEducationalRecords
NOTICEANDINSTRUCTIONS: TheFamilyEducationRightsandPrivacyActof1974(FERPA),protectspersonallyidentifiableinformationinstudenteducation
records(suchasthestudent’sname,address,financialrecords,andgrades)fromdisclosurewithoutthestudent’ssigned,writtenconsentunlesssuchconsentisnot
requiredbylaw.Studentsarenotrequired
toauthorizedisclosureofinformationfromtheireducationrecords.ThisauthorizationformwillallowofficialsatTexas
Woman’sUniversitytoreleaseinformationspecifiedbyyoutoindividuals/organizationsidentifiedbyyouontheformwhenwrittenauthorizationisrequired.Please
fillinalloftheblanksandcheckthe
boxesthatapply.Uponcompletion,signyournameandincludethedateyousignthisauthorizationform.Returntheformto
theOfficeoftheRegistrar(ADM128)POBox425559Denton,TX76204Fax:9408983205registrar@twu.edu
AgovernmentissuedphotoIDofthestudentisrequiredwiththisform.Ifmailedorfaxed,anenlargedcopyofphoto
IDwithasignatureisrequired.
StudentInformation:
LASTNAME
FIRSTNAME STUDENTID#
CONTACTPHONE#
UNIVERSITYEMAILADDRESS DATEOFBIRTH
I,_______________________________ ____________,herebyvoluntarilyauthorizeTexasWoman’sUniversityofficials
PRINTNAMEOFSTUDENT
toreleasetheselectedinformationtotherecipientlistedbelowforthepurposeof____________________________
___________________________(i.e.providingaccesstoparen ts,scholarshipapplication,reimbursementfrom
employerorothersource,etc.).
Accesstostudentrecordswillonlybegrantedtotheindividual(s)listedbelow whentheyprovidetheaccesscodeyou
assign.Besuretogivetheaccesscodetotheperson(s)identifiedbelow.Theaccesscodeiscreatedbyyouonlyforthe
purposeofthisrelease,andcanbea
singlewordorphrase.AccessCode:_____________________________________
Individual(s)toreleaseinformationto:
LASTNAME FIRSTNAME CONTACT# RELATIONSHIP
LASTNAME FIRSTNAME CONTACT# RELATIONSHIP
EducationalInformationtoRelease(checkone):
TypeofRecord Description
AllAcademicRecords
Includesadmission,registration,financialaid,studentaccount/billing,enrollment,grades,TSI,etc.
PartialAcademicRecords
Specifyrecordstobeshared(i.e.academic,financialaid,studentaccount/billing,housing,etc.)
1.
2.
3.
4.
Thisauthorizationisvaliduntilcanceled.Thestudentmaycancelthisreleaseatanytimebysubmittingawrittenand
signedrequesttorescindthereleaseofrecordstotheTexasWoman’sUniversityOfficeoftheRegistrar.
StudentSignature:_______________________________________________Date:______________________________


DateStampReceived
FOROFFICEUSEONLY
IDType:_______________________Verifiedby:________________________Date:________________