Beloit College – Student Financial Records Information
Release Form
The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student education
records. FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the
student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the
rights have transferred are "eligible students." Eligible students may give written consent authorizing disclosure of
information to parents (custodial or non-custodial) or other third parties. If you wish to allow access to your student
account, financial aid, or tax/payroll information, you must complete this form and return it to the Financial Aid Office,
2
nd
floor Pearsons Hall or securely upload the document at https://beloit.leapfile.net
S
tudent Name:_____________________________ Student ID Number: ________________
I, the undersigned, hereby do not authorize the Beloit College Accounting, Financial Aid, or Payroll
Offices to release to or to discuss with anyone, other than myself, my student financial records.
I, the undersigned, hereby authorize the Beloit College Accounting, Financial Aid, and Payroll Offices to
release to or discuss with the following individuals, information related to my student financial records.
1
: Name ___________________________________ Address ________________________________________
Relationship to student _______________________ City, State, Zip___________________________________
Email _____________________________________ Phone _________________________________________
2: Name ___________________________________ Address ________________________________________
Relationship to student _______________________ City, State, Zip___________________________________
Email _____________________________________ Phone _________________________________________
3: Name ___________________________________ Address ________________________________________
Relationship to student _______________________ City, State, Zip___________________________________
Email _____________________________________ Phone _________________________________________
This release will remain in effect until revoked by me, in writing, and submitted to the Beloit College Financial
Aid Office. Any such revocation will not affect disclosures made prior to receipt of written revocation.
Student Signature ___________________________________________ Date _________________________
For more detailed information regarding Family Educational Right to Privacy Act (Buckley Amendment) please go
to:
https://www.beloit.edu/registrar/ferpa_bc_overview
You may only check one box below:
click to sign
signature
click to edit
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