Pick up checks
Verbally release information
To be released to:
Information to Family Member Listed below
Name of Contact:
Relationship to Student:
Phone Number:
Email Address:
Student Signature Print Name Date
Family Education Rights and Privacy Act
The purpose of The Family Education Rights and Privacy Act of 1974 is to assure that all students, including those attending
an institution of post secondary education, have access to their educational records and to protect such individualsright to
privacy by limiting transferability of their records without their consent.
TULALIP TRIBES HIGHER EDUCATION FUNDING PROGRAM supports this Act and maintains access for students to
review the validity of their educational records.
Updated Waiver Release Form: 10/2017 jys
Student Name
DOB: ___________ do hereby give permission for the individual/organization listed below to
have access to the following information. I am aware this restriction is valid only for the
academic year in which it is signed. I understand this form is valid only for the academic
year noted above and that new form must be completed for each academic year I wish
third party information released.
(Check all that apply)
7707 36th Ave NW, Bldg D1, Tulalip, WA 98271 • 360-716-4888 • 360-716-0398 (Fax) • highereducaon@tulaliptribes-nsn.gov
The Family Education Rights and Privacy Act
Waiver Release Form
For Academic Year 2020-2021
Higher Education
click to sign
click to edit