Fill - Free fillable Ferpa Student Consent PDF form

FERPA Consent Form

For Release of Records

Under the Family Educational Rights and Privacy Act of 1974, I understand that my educational records

cannot be released or discussed without my permission.

__________________________________________________________________________________________

First Name Last Name Student ID #

__________________________________________________________________________________________

Date of Birth Phone Number

I, therefore, give permission for my educational records to be discussed with or released to the following:

Full Name (Printed) Relationship

Information to be released:

This permission to release my records or academic information to the individual or individuals named on

this form applies to (check one):

This specific request only.

This request and any future requests one year from the date of this signed form.

Signature of Student______________________________________________ Date______________________

REVOCATION OF CONSENT (not valid until received by the Records and Registration Office)

I hereby revoke the consent granted above.

Signature of Student_________________________________ Date______________________

Fill Online, Printable, Fillable, Blank Ferpa Student Consent Form