3050 Martin Luther King, Jr. Drive Shreveport, LA 71107
Phone: 318-670-9229 Fax: 318-670-6344
Parent FERPA Request Form
It is the policy of Southern University at Shreveport (SUSLA), in accordance with the Family Educational Rights
and Privacy Act (FERPA), to withhold personally identifiable information contained in our students’ educational
records unless the student has consented to disclosure or FERPA allows disclosure. Directory information, such
as name and address, may be disclosed to the public upon request. However, private information, such as grades,
class schedules, the student’s account, and financial aid awards may not be released without expressed consent
from the student.
Parent(s) or guardian(s) may request access to their student’s record without the student’s written permission if
the parents or guardians claim the student as a dependent according to the Internal Revenue Service code.
I, _______________________________________, am the _______________________________________ of
(Parent/Guardian Name) (Parent/Guardian Relationship to the Student)
_________________________________________, SUSLA ID# ______________________ and have attached
(Student’s Legal Name)
a copy of the last available year’s IRS Federal Tax Return or other appropriate legal documentation, showing that
he/she is my dependent.
Under the provisions of FERPA, I understand that I have the right to review and inspect the educational records
of my dependent as defined in Section 152 of the Internal Revenue Code.
In accordance with the above provision, I certify that the student whose name appears above is my dependent and
therefore, request access to the following educational record(s):
_______ All Financial Records in the Student Accounts Office
_______ All Financial Aid Information
_______ All Academic Records
_______ Other _____________________________________________________
Parent’s Signature: ______________________________________________ Date: __________________
This authorization will remain in effect as long as the student remains in continuous enrollment at Southern University at Shreveport.
Should the student’s dependency status change during his or her enrollment period, it will be the responsibility of the student to notify
the Unit of Student Records/Registrar of his or her change in status.
eturn this completed form and documentation to the address above.
RO: Parent FERPA Request Form:LR/11-13
Copy – Registrar’s Office Copy – Financial Aid Copy – Student Accounts