North Central Kansas Technical College
Beloit-Hays, Kansas
Student Authorization for Release of Education Records Information
In compliance with the Federal Family Education Rights and Privacy Act of 1974 (FERPA Of the Buckley Amendment)
NCK Tech is prohibited from providing certain information from your student records to a third party, such as information on
grades, billing, tuition and fees assessments, financial aid (including scholarships, grants, work study, or loan amounts) and
other student record information. This restriction applies, but is not limited to your parents, your spouse or any other third party.
You may, at your discretion, grant NCK Tech permission to release information about your student records to a third party by
submitting a completed Student Authorization for Release of Education Records Information. You must complete a separate
form for each third party to whom you grant access to information on your student records. The specified information will be
made available only if requested by the authorized third party. NCK Tech will not automatically send information to a third
Submit your completed form to the Registrar's Office in person, via NCK Tech email or fax. You must show a valid
government issued photo ID when submitting In person or attach a copy of submitting via fax. Please note that your
authorization to release Information has no expiration date; however, you may revoke your authorization at any time by
contacting the Registrar's Office.
A. Student Information
First Name Last Name Mi Social Security # Student ID Number Date of Birth
(last 4 digits only)
Current mailing address (street or PO Box number, Apt number) City State Zip code
Phone Number
SECTION B. Person/Third
Party Designee
authorized to receive information (Parent, Guardian, etc.)
Name P
hone Number
Current mailing address (street or PO Box number, Apt number) City State Zip code
Relationship to student Code word to grant access
Types of Education Information to Release
All Records
All records listed below
Financial Aid
All records to include; FAFSA application data, financial aid disbursements, eligibility,
and financial aid, satisfactory academic progress status and any other information
contained in the allocation of financial aid file)
Grades/GPA, demographic, registration, student ID number, academic progress status,
Student Accounts
Billing statements, charges, credits, payments, past due amounts, collection activity, and
any communication history
To include: videos, email blasts, recruiting brochures, newsletters, magazines, general
publications, website and/or affiliates, other
Please specify
The Family Educational Rights and Privacy Act (FERPA or the Buckley Amendment) is a Federal law that protects the privacy of student
education records.
law applies to all schools that receive funds under an applicable program of the U.S. Department
FERPA gives parents certain rights
respect to their children's education records.
These rights transfer to the student when he or she reaches the
of 18 or attends a school beyond the high school level. Students to whom
the rights have transferred are "eligible students.·
Parents or eligible students have
right to inspect and review the student's education records maintained by the school. Schools are
not required to provide copies of records unless, for reasons such as great distance,
is impossible
parents or eligible students to
review the records. Schools may charge a fee for copies.
Parents or eligible students have the right to request that a school
records which they believe to
inaccurate or misleading. If
the school decides not to amend the record, the parent or eligible student then has
right to a formal hearing. After the hearing,
the school still decides not to amend the record, the parent or eligible student has the right to place a statement with the record
setting forth his or her view about the contested information.
Generally, schools must have written
from the parent or eligible student in order to release any information from a
student's education
However, FERPA allows schools to disclose those records, without consent, to the following parties or
under the following conditions:
hool officials with legitimate educational interest;
Other schools to which a student is transferring;
Specified officials for audit or evaluation purposes;
Appropriate parties in connection
financial aid to a student;
Organizations conducting certain studies for or on behalf of the school;
Accrediting organizations;
To comply with a judicial order of lawfully issued subpoena;
Appropriate officials in cases of health and safety emergencies; and State and local authorities, within a juvenile justice
system, pursuant to specific State
Schools may disclose, without consent, "directory" information which includes: student's name, address, telephone number, date of birth,
honors and awards, dates of attendance, electronic mail address, Student user ID that alone cannot
used to gain access to education
records, photograph, major field
study, grade level, enrollment status, degrees, most recent educational agency or institution attended,
participation in officially recognized activities
sports. However, schools must tell parents and eligible students about directory information
and allow parents and eligible students a reasonable amount of time to request that the school
disclose directory information about them.
Schools must
parents and
students annually of their rights under FERPA. The actual means of notification (special letter,
inclusion in a PTA bulletin, student handbook, or newspaper article) is left to the discretion of each school.
Family Policy Compliance Office
U.S. Department of Education
400 Maryland Avenue, SW
Washington, D.C. 20202-5920
SECTION C. Certification
I authorize the above third party, named in Section B, to access the above indicated student record information. This authorization does not permit the third
party to make any changes. Furthermore, I acknowledge that I have read and understand the above language regarding the Family Education Rights and
Privacy Act (FERPA)
Student's Signature (Enter Date of Birth to Electronically Sign) Date
NCK Tech
committed to nondiscrimination on the
ethnic or national origin,
sexual orientation, gender identity, marital status,
religion, age, ancestry, disability, military status, or veteran status in admission or access to, or treatment or employment in, its programs and activities. Further,
it is the policy of the college to prohibit harassment (including sexual harassment and sexual violence) of students and employees. Any person having inquiries
concerning the college's compliance with the regulations implementing Title VI, Title VII. Title IX, Section 504, and the Americans with Disabilities Act
Amendments Act is directed to the Dean of Instructional Services (Section 504/ADA Compliance Officer) or the Dean of Student Services (Title VI. Title VII. &
Title IX Compliance Officer) at
or PO Box 507, 3033 US Hwy 24, Beloit, KS 67420.
Last Updated 6
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