Minnesota State University, Mankato
Student Financial Services and Office of the Registrar
Authorization for Release of Financial and/or Enrollment Information
Name _____________________________________________ Minnesota State Mankato Tech ID No.________________________
City, State, Zip _________________________________________________________________________________________________
Area Code and Phone No. ________________________________________________________________________________________
In compliance with the Federal Family Education Rights and Privacy Act of 1974, the Minnesota Government Data Practices Act, and the
University’s policy on Access to Student Records, information about a student’s account may not be released to a third party without the
student’s written permission. This includes a parent, spouse, sponsor, relative, organization, etc.
If you would like a third party to have access to your financial and/or enrollment information, please complete and sign this authorization and
117 Centennial Student Union
Mankato, MN 56001
If you are mailing this document, you will need to sign the form in front of a notary public (see below).
Additional forms are available if you are granting access to more than one third party. This authorization does not pertain to details
regarding student conduct or disciplinary matters, residence hall conduct issues, medical, academic advising or counseling services records.
Requests for information maintained by other offices must be made directly to those offices. This authorization form will be kept on file at
the Campus Hub throughout the effective dates.
I, ______________________________, do hereby authorize Student Financial Services and Office of the Registrar staff at Minnesota State
(print name) University, Mankato to release (please
any or all boxes that apply)
Financial aid information and data Registration information (Enrollment/Grades/Academic Records/
Academic Probation/Academic Suspension) Note: This
All billing charges and payment information authorization does not allow third party to obtain student’s
Unofficial/Official Transcripts or DARS Report.
Student payroll information
from my Minnesota State University, Mankato student files to: (Provide name and address of person or persons at same address to whom
information is to be released and that person(s) or organization’s relationship to you.)
Name of person(s)/organization ______________________________________ Address _______________________________________
City, State, Zip ______________________________________ (relationship to you) _________________________________________
Indicate the purpose for the release of information: ___________________________________________________________________
* Please honor this authorization through _______________________ (Date). If no date is specified, this authorization will be
honored for one year after your last term of enrollment or until you notify us in writing to cancel it.
Note: This authorization applies only to financial and enrollment records. It does not authorize access to details regarding student conduct
or disciplinary matters, residence hall conduct issues, medical, academic advising or counseling services records maintained by the
Student’s Signature ___________________________________________________________ Date __________________
A member of the Minnesota State Colleges and Universities System.
Minnesota State Mankato is an Affirmative Action/Equal Opportunity University.
This document is available in alternative format to individuals with disabilities by calling the
Campus Hub at 507-389-1866 (V), 800-627-3529 or 711 (MRS/TTY).
Staff approved _____ (Initials) Data Entered _____ (Initials) Rev. 11-09
State of _________________) On this ____ day of ________________ __________________ personally
SS appeared before me, whose identity was proved to me on the basis of
County of __________________) satisfactory evidence to be the person whose name is subscribed to this
instrument, and acknowledged that he executed it.
Signature of Notary Public