Carroll Community College
1601 Washington Road
Westminster, MD 21157
Phone: 410-386-8440 Fax: 410-386-8446
Permission to Release
Educational Record Information
The Family Educational Rights and Privacy Act (FERPA) prohibits the College from releasing any student
educational record information to a third party without the student’s written permission. By signing this form
the student agrees that the College may release the following educational record information at the request of a
• Account/Billing information
• Financial Aid information (allowed in person only, with photo identification: eligibility status, award
types, amounts, disbursement dates)
I, ____________________________, give permission for Carroll Community College to release the above
(Printed Student Name)
information, upon request, to my designee(s): _________________________ ________________________.
This release form is good for three (3) years from the date below or until the end of _____________________.
(Year/Term, if less than 3 Years)
Student Signature Date
Student Identification Number
The College will not initiate a release of educational record information; the designee must request the information in person with
photo ID. Please note: for dual students only, mid-term grade reports and final grade unofficial transcripts are automatically
mailed to the student’s home address and high school guidance office.
The College may release directory information to third parties. Directory Information includes the following: student’s name, dates
of attendance (i.e. registered in which terms), enrollment status (full-time vs. part-time) major field of study, participation in college-
recognized activities, intramural sports, degrees, awards received and hometown. Please note: Only Directory Information may be
provided by phone.
Information will be forwarded to you at the request of the student with the understanding that it will not be released to other parties.
The Family Educational Rights and Privacy Act of 1974, as amended, prohibits release of this information without the student’s
written consent. Please return this material to us if you are unable to comply with this condition of release.
For Office Use Only: Action taken by: __________ Date: ___________________