Trinity Bible College
Trinity Bible College
Oce of the Registrar | Trinity Bible College | 50 6th Avenue South | Ellendale, ND 58436-7105
phone: 701.349.5796 | fax: 701.349.5786 | email: | website:
FERPA Release Form
Name:__________________________________________________ Student ID Number:_____________________
In accordance with the Family Educational Rights and Privacy Act (FERPA), Trinity Bible College withholds personally identiable information contained in our students’ educational records unless the
student has consented to disclosure or FERPA allows disclosure. Directory information (described below) may be disclosed to the public. However, private information, such as grades, class
schedules, student account information, and nancial aid awards, may not be released without express consent from the student. Signing this form provides such consent,
according to the information designated for release and to whom it will be released.
I, (the undersigned), hereby authorize Trinity Bible College to release the following educational records, upon request, to the persons listed below, for the
purposes of keeping them informed regarding my education at Trinity Bible College.
Please initial all that apply:
______» All nancial records in the Student Accounts oce
______» All nancial aid information
______» All academic records
______» All records in the Student Life oce
Person(s) to whom information may be released:
Name:____________________________________________ Relationship to you:___________________________
Name:____________________________________________ Relationship to you:___________________________
Name:____________________________________________ Relationship to you:___________________________
I acknowledge by my signature that I understand that, although I am not required to release my records, I am giving my consent to release the information.
I understand that this release remains in eect unless I revoke such consent in writing and revocation is delivered to the institution.
Please consider very carefully the consequences of any decision by you to withhold “Directory Information. Should you decide to inform the institution not
to release this “Directory Information, any future requests for such information from non‐institutional persons or organizations will be refused.
Schools may disclose, without consent, directory information. The primary purpose of directory information is to allow Trinity Bible College to include this
type of information from your educational records in certain school written and online publications. Examples include: a playbill, showing your role in a
drama production, Deans List or other recognition lists, graduation programs, and sports activity sheets showing weight and height of team members.
“Directory Information as described by Trinity Bible College includes:
» Student’s name
» Address
» Telephone listing
» Electronic mail address
» Photographs
» Date and place of birth
» Major eld of study
» Dates of attendance
» Grade level
» Participation in ocially recognized activities and weight and height of members of athletic teams
» Degrees, honors, and awards received
» The most recent educational agency or institution attended
If you do not want TBC to disclose directory information without your prior written consent, you must ll out a FERPA Non-Release form in the Academic Records Oce within 15 days of the rst
day of classes. This will be considered valid and will remain in eect until it is countermanded, in writing, as long as you are an eligible student. You may also ll out the FERPA Release form for
other parties to have access to non‐directory information.
Signed:_________________________________________________ Date:_________________________________
Electronic copy housed in Academic Records. Original housed in Student Life. Entered into Empower by: _________________ Date:___________
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