Fillable Ferpa Student Information Release (FERPA)

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Ferpa Student Information Release (FERPA)

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Student Information Release
(FERPA) Authorization Form
BACKGROUND:
The Federal Education Rights and Privacy Act (FERPA) is a federal law that protects the right to privacy and
confidentiality of a student’s educational records. In compliance with FERPA, the Office of Student Financial Aid is
unable to disclose financial aid information to anyone other than the student without a signed release form.
Exception: Financial aid information will be provided to offices or persons within the college who assist with the
administration of the financial aid programs, as well as to organizations and government entities that require the
information to award financial assistance or that require reports or other data to be submitted in order to remain in
compliance with federal and state regulations.
SECTION A: STUDENT INFORMATION
Student Name:
MC ID#:
Street Address:
City:
State:
Zip Code:
Preferred Phone #:
Alternate Phone #:
SECTION B: AUTHORIZATION
This authorization is valid only for the CURRENT ACADEMIC YEAR _20/ - 20/.
I authorize the Financial Aid Office to discuss my financial aid and/or release financial aid information to the following
individual(s).
I have the right to revoke this authorization at any time by notifying the Office of Student Financial Aid in writing that I
wish to cancel it.
SECTION C: AUTHORIZED INDIVIDUAL(S)
Name: Relationship to Student:
Name: Relationship to Student:
SECTION D: STUDENT SIGNATURE
________________
______________________________________________________________
Student Signature (must be signed in ink)
Date
This form must be presented and signed in person by the student at the Office of Student Financial Aid.
Montgomery College Office of Student Financial Aid
Germantown Rockville Takoma Park/Silver Spring
Phone: (240) 567-5100
FinancialAid@montgomerycollege.edu
M
Code: FERPA / FA FERPA
Office of Student Financial Aid
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Ferpa Student Information Release (FERPA)

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Completed 8 April 2020

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