COMMUNITY COLLEGE OF ALLEGHENY COUNTY
Allegheny Campus Boyce Campus North Campus South Campus
808 Ridge Avenue 595 Beatty Road 8701 Perry Highway 1750 Clairton Road
Pittsburgh, PA 15212 Monroeville, PA 15146 Pittsburgh, PA 15237 West Mifflin, PA 15122
Ph: 412.237.2589 Ph: 724.325.6602 Ph: 412.369.3656 Ph: 412.469.6241
FAX: 412.237.3171 FAX: 412.237.3173 FAX: 412.237.3175 FAX: 412.237.3177
Financial Aid Release of Information Form
Certification of Information
FERPA—Release of Financial Records
I, , hereby authorize the
[print student’s name]
of Community College of Allegheny College to release my
[department name here]
various records and personal information to:
[print name(s) of authorized recipient(s)]
I acknowledge that such information and records may include, but not necessarily be limited to:
By signing below, I hereby provide my permission for any and all pertinent information and/or
records to be released and/or shared accordingly.
Signature: Date:
Name: Date of Birth:
PLEASE PRINT NAME
Student Social Security Number/Student ID#
*The Community College of Allegheny County is subject to the provisions of and complies with the Family Education Rights and Privacy Act of 1974 (―FERPA‖). A
statement of the college policy can be found in the student handbook and college catalog. FERPA defines an ―educational record‖ as ―those records, files, documents,
and other materials‖ that (1) ―contain information directly related to a student; “and (2) ―are maintained by an educational agency or institution or by a person acting
for such agency or institution.”
Revised April 10, 2017
Notifications of nondiscrimination and contact information can be found at https://www.ccac.edu/nondiscrimination/
click to sign
signature
click to edit
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