TULSA
COMMUNITY
COLLEGE
Includes
tuition
and fee balances, financial holds, mailing and billing address, payment plans, accounting state-
ments and collections,
debt
information, and any
other
accounts receivable information contained in student
account records.
Includes dates
of
application, programs selected, documents received, documents pending, dates
of
admission,
admission status, conditions
of
admission, and any
other
information contained in student admission records.
Includes current
class
schedule, dates
of
enrollment
activity,
enrollment
status, residency status, semesters attend-
ed, test scores, mailing address information and any
other
information contained in student
enrollment
records.
Includes courses taken, grades received,
GPA,
academic progress, honors, transfer credit awarded, degrees award-
ed, and any
other
information contained in the academic records.
Includes all general financial aid information. Includes status
of
file, award and disbursement
of
funds information,
Satisfactory Academic Progress, income information, and any
other
information contained in student financial aid
records.
Includes all disciplinary records contained in student files.
FERPA Student Records Release Form
Revised 4-19-18
It is the policy of Tulsa Community College, in accordance with the Family Educaonal Rights and Privacy Act of 1974 (FERPA), to withhold person-
ally idenable informaon contained in our students’ educaonal records unless the student has consented to disclosure or FERPA allows disclo-
sure. A descripon of these rights can be viewed in the TCC Student Policies and Resources Handbook.
Student ID Number: T__________________ Full Legal Name: ______________________________________________________
Types of Informaon to Release: (Check all that apply)
All Records
Accounng Records
Admission Records
Enrollment Records
Academic Records
Financial Aid Records
Disciplinary Records
I give permission to Tulsa Community College to release the selected informaon to the recipient(s) listed below:
Check one box per line:
__Release to __ Revoke access to Name: ______________________________ Relaonship: __________________________
__Release to __ Revoke access to Name: ______________________________ Relaonship: __________________________
__Release to __ Revoke access to Name: ______________________________ Relaonship: __________________________
Statement of Understanding:
I understand that informaon releases remain in eect unl I revoke such consent in wring and the revocaon is delivered to a TCC Enrollment Services
Oce.
My signature indicates my consent to release or to revoke the above informaon to the designated individual(s)/organizaons(s) listed on this release.
I also understand that if I am a dependent for tax purposes, TCC can disclose such informaon's to parents and legal guardians regardless of my consent.
Medical records are not covered under FERPA rules.
Signature:______________________________________________________________________ Date: ______________________
Return to any campus Enrollment Services oce or return by mail or e-mail with a copy of Student’s Valid Photo ID to:
Records and Student Compleon Services, Tulsa Community College
909 S Boston Ave Tulsa, OK 74119
records@tulsacc.edu
OFFICE USE ONLY:
___ Student returned in person– Sta Veried Photo ID ___ Student returned via TCC E-mail Account ___ Student returned via fax or e-mail w/ Photo ID
Received by: _______________________________________________________________________________________________________ Date: ______________
