The Family Educational Rights and Privacy Act (FERPA) of 1974 is a Federal law that protects
the privacy of student education records. FERPA prohibits the release of student education
records without the student’s prior written authorization. In order to disclose a student’s
education records, the institution must:
Have a student's consent prior to the disclosure of education records;
Ensure that the consent is signed and dated and states the purpose of the disclosure.
As the authorized chapter representative for my fraternity/sorority chapter, I affirm the following:
I have been authorized by my chapter to receive education records (semester and
cumulative grade point averages) for the active and new members of my chapter.
I acknowledge receipt of these education records from the Director of Fraternity and Sorority
I understand that I will receive members’ education records for all academic sessions/terms
enrolled in during the current year, until such time that I am no longer the authorized chapter
I will only receive education records for members who have signed the Grade Release Form
and are listed as members on my chapter’s official roster for each semester.
I understand that my members’ education records are confidential, and are protected under
FERPA. As such, I have a legal and ethical responsibility to use this information in an
appropriate manner, and will only disclose this information to the following parties:
o Chapter president;
o Chapter/faculty advisor(s);
o Chapter scholarship chairperson;
o National headquarters staff;
and will only use members education records for the following purposes:
o Determining membership eligibility in my chapter;
o For use in chapter scholarship, educational, and award/recognition programs.
I have read this form and agree to the provisions outlined above.
________________________________ __________________ _____________________
Authorized Chapter Representative Student ID Fraternity/Sorority Chapter
________________________________ _______________ ________________________
Signature Date Office/Position in Chapter
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