CCC Financial Aid FERPA Release Form
THIS RELEASE IS GOOD FOR THE CURRENT AID YEAR ONLY.
The Family Educational Rights and Privacy Act (FERPA) of 1974 is a federal law designed to protect the privacy aspects of
a student’s educational record. Educational records include financial aid and student account records which are
considered confidential and will not be released without written consent from the student. For this reason, it is
necessary for the Office of Financial Aid at Clovis Community College to obtain permission from a student in order to
release financial information.
* Please Note: FERPA pertains to the release of records only. This form does not give others the right to act on your
behalf or to change your records.
Student Section:
If you are not completing this form in the presence of a CCC Financial Aid employee, this form must be notarized. You
are also required to submit a clear photocopy of your picture ID and that of the named person(s) listed below in order
for this form to be valid.
I understand this release pertains only to my financial records and does not allow the individuals named below access to
information from any other department or office. I agree to waive my rights under FERPA and allow the Clovis
Community College Financial Aid Department to release information to the below named person(s):
Name: Relationship:
Name: Relationship:
Name: Relationship:
Name: Relationship:
Information I wish to be released:
Tax Information All Information
Other (Please be specific):
I acknowledge by my signature that I understand although I am not required to release my records, I am giving my
consent to release information. I understand that this release remains in effect unless I rescind such consent in writing.
Please Print Name:
Student ID: C
Signature: Date:
__________________________________
[Signature of Notary]
[Notary Seal]
__________________________________
[Printed name of Notary] My commission expires: ________________, 20____.
For Office Use Only: Received Date Stamp:
Copies of Photo ID’s attached Notarized
RHACOMM Updated Archived
Current Aid Year:
Financial Aid Specialist Signature: Date:
Financial Aid Student Employee Signature: Date:
click to sign
signature
click to edit
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