Oce of the Registrar | Trinity Bible College | 50 6th Avenue South | Ellendale, ND 58436-7105
phone: 701.349.5796 | fax: 701.349.5786 | email: registrar@trinitybiblecollege.edu | website: www.trinitybiblecollege.edu
FERPA Release Form
Name:__________________________________________________ Student ID Number:_____________________
In accordance with the Family Educational Rights and Privacy Act (FERPA), Trinity Bible College withholds personally identiable 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 oce
______» All nancial aid information
______» All academic records
______» All records in the Student Life oce
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 eect 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, Dean’s 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 ocially 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 Oce within 15 days of the rst
day of classes. This will be considered valid and will remain in eect 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:___________
click to sign
signature
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