Office of the Registrar
Academic Building D-224
reg@ramapo.edu
ID Verified:_______________________ Received: ___________
Waiver Valid Until: Processed (SPACMNT): ___________
P:\Shared\Registrar\FERPA\FERPA WAIVER-REVISED 12.14.2018.docx
FERPA WAIVER
PLEASE PRINT
______________________________________________ __________________________
Student’s Name (LAST, FIRST, MIDDLE INITIAL) R#
In accordance with The Family Educational Rights and Privacy Act (FERPA), Ramapo College of New Jersey will only
disclose confidential information from the education records of students to parents or other third parties provided the
College has written consent from the student on file. This form is provided as a means for students to give the Registrar
(or designee) permission to discuss their educational records with someone other than themselves (i.e., with a parent,
guardian, etc.).
Written consent will be kept permanently on file, and the Office of the Registrar (or designee) will release information
regarding the student’s education record to the person(s) who have been designated on this form. If for any reason a
student decides to cancel this release, he/she must submit a letter withdrawing the consent, indicate the person(s)
affected, and send or deliver the written notice to: Ramapo College of New Jersey, Office of the Registrar, 505 Ramapo
Valley Road, Mahwah, NJ 07430.
By signing below, I consent that Ramapo College of New Jersey may disclose and discuss the following confidential
information with the individual(s) referenced on this form (please check all that apply):
□ Academic Records (grades, transfer information, academic standing, grade point average, schedule of classes)
□ Financial Information (bill, tuition/fees, past due amount, payments made, loan/grant/scholarship information)
□ Student Life (disciplinary information, student status, residential life information)
□ Other: _____________________________________________________________
Information may be released to: (Please Print)
__________________________________________ _____________________________
Name Relationship to Student
__________________________________________ _____________________________
Name Relationship to Student
Personal Security Statement (select one): Student must share this statement with the individual(s) listed
above – information will not be released unless the third party can identify the correct statement chosen.
□ The Name of student’s Elementary School is: ______________________________________
□ The Name of student’s First Pet is: ______________________________________
□ The Student’s First Vehicle Make/Model was: ______________________________________
______________________________________________ __________________________
Student’s Signature Date
click to sign
signature
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