The required information is necessary for the continuous legitimate business and educational operation of Eastern Michigan University. It is, and will be, maintained in compliance with applicable US law,
educational accrediting body requirements, and institutional policies and procedures. Questions or concerns may be directed to the Office of Records and Registration at registrar@emich.edu.
Federal law prohibits EMU from discussing information with anyone other than the student, unless authorized in writing by the student.
This is effective until the cancellation of release has been requested by the student. Please submit form to Service EMU, 268 Student Center.
Section I – STUDENT INFORMATION
Student’s Name
E- Number
or
SS #
(last 4 digits)
Section II – AUTHORIZATION INFORMATION
(Please complete section I also)
I authorize only the person or persons listed below to receive information
I
Name Relationship SS
# (last 4 digits)
E-Mail Address
II Name Relationship SS
# (last 4 digits)
E-Mail Address
I authorize EMU to release the following information (Check all that apply)
Academic Information: (including but not limited to) Grades, Enrollment Level, Course Selection, Attendance
Financial Aid Information: Satisfactory Academic Progress, Grade Point Average, FAFSA (Free Application for
Federal Student Aid) Information, Award Amounts
Student Account Information: Account Balances, Account Charges, Billing, Payments
Section III – CANCELLATION OF RELEASE
(Please complete section I also)
I request the person or persons’ authorization listed below to be cancelled
I
Name Relationship
II Name Relationship
I request the cancellation of the release of the following information (Check all that apply)
Academic Information: (including but not limited to) Grades, Enrollment Level, Course Selection, Attendance
Financial Aid Information: Satisfactory Academic Progress, Grade Point Average, FAFSA (Free Application for
Federal Student Aid) Information, Award Amounts
Student Account Information: Account Balances, Account Charges, Billing, Payments
Student’s Signature Date
For office use only:
Receiving Office Processed by Date
Office of Records and Registration
Eastern Michigan University
304 Pierce Hall ● Ypsilanti, MI 48197
Phone: (734) 487-4111 ● Fax: (734) 487-6808
registrar@emich.edu
Authorization to Release FERPA
Protected Information
click to sign
signature
click to edit
![]()
