Fillable Information Authorization to Release (Henry Ford College)

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Information Authorization to Release (Henry Ford College)

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Registration and Records
Authorization to Release
Information
Instructions
Revised 05/14
The Family Educational Rights and Privacy Act (FERPA) of 1974 is designated to protect the
privacy of educational records, to establish the rights of students to inspect and review the
educational records, and to provide guidelines for the correction of inaccurate or misleading
data through informal and formal hearings.
Henry Ford College’s procedures for complying with the provisions of this Act are available in
the Student Handbook as well as the catalog and College website. In accordance with
FERPA, the College may not discuss a student’s academic and/or financial information to their
parents, spouses, or guardian of the student.
By completing and signing this form, the student below authorizes Henry Ford College to
discuss the designated information with the student’s designee (parent, spouse, relative,
guardian, etc.)
The student should give great consideration to this before choosing this option and submitting
this form. The student should know that by signing this form, College personnel will disclose
any information pertaining to the student’s academic record, financial aid status and student
financial account. This authorization will remain in effect until the student submits written
notice terminating this consent to the Office of Registration and Records.
Registration and Records
Authorization to Release
Information
Student Information
Student Name: ____________________ HANK ID Number: ____________________
Student Authorization
I have read this document and fully understand the contents. I agree to release all information related
to my academic, financial aid, financial account and other records at the College to: (Name or names
must be indicated below)
Name of individual to whom information can be released: ____________________
Relationship to student: ____________________
Name of individual to whom information can be released: ____________________
Relationship to student: ____________________
This term begins: Fall Winter Spring/Summer Year: 20___
____________________
: ____________________ ____________________
To protect my privacy, when inquiring about my educational records at the College, the above-indicated
individual(s) should use the following PIN:
Student Signature:
_____________________________
______________________
Date:
Office Use Only:
Date Received Date Entered in Colleague:
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Information Authorization to Release (Henry Ford College)

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Completed 17 September 2020

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