FERPA Release Form
(Family Educational Rights and Privacy Act)
If you wish to give Webster University permission to discuss your records with another party
(parents, spouse, employer, etc.) please complete this authorization form. These records could
include, but are not limited to, academic records, financial records, and files from the dean of
students office.
I hereby give Webster University permission to discuss my records with the following:
Name Relationship
RelationshipName
RelationshipName
Social security number or
Student I.D. number
Date
Student Signature
This authorization is not effective until it is received in the Registrar's Office, Webster
University, 470 E. Lockwood, St. Louis, MO 63119-3194.
This authorization will remain in effect until written notification, canceling this authorization,
is received in the Registrar's Office from the above signed student.
Webster University Registrar's Office Loretto Hall 63 St. Louis, MO 63119
Once you have printed and signed this form you may fax it to 314-968-7112 or mail it to:
