Fillable Release Of Information Request Form ODD (Wright State University)

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Release Of Information Request Form ODD (Wright State University)

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Financial Aid
Release of Information
Request
Office of Financial Aid
130 Student Union
3640 Colonel Glenn Hwy.
Dayton, OH 45435-000
Phone: (937) 775-4000
E-mail:
RaiderConnect@wright.edu
FAX: (937) 775-4410
Section 1: Student Information
Last Name
First Name
Phone Number
University ID Number (UID)
Section 2: Release of Information
If you are requesting enrollment verification or grades, please refer to the Enrollment and Degree Verification and Grades Transcript sections of the
RaiderConnect webpage. Complete this section based on the party in which the information should be released (i.e. student, parent, or third party). If the
request can not be granted, an e-mail will be sent to your Wright State University e-mail address.
Information to be released to the student (check all that apply)
Copy of Appeal Documents.
Complete Attached Form
Information to be released to the parent
Copy of parent tax documents (Please note: a signature of the parent whose tax documents are being released must be supplied.)
Parent Signature
Date
Information to be released directly to a third party (check all that apply)
Federal regulations prohibit Wright State University to release information to third parties, even with a student’s express written consent, unless the third party
is an organization that will assist you, the student, in applying for and receiving financial assistance for your education at Wright State University (ex. external
scholarship donors, HUD, Section 8 housing). By completing the information and signing below, you are acknowledging that the third party specified is an
organization that will assist you, the student, in applying for and receiving financial assistace for your education at Wright State University and the specified third
party shall not sell or share the information provided. If the third party requesting information is not associated with determining eligibility for financial
assistance for your education, you the student must provide the information directly to the third party.
Complete Attached Form
Copy of Award
Notice
Other_____________________________________
Reason for Release
City, State, Zip Code
Section 3: Academic Year
Please sepecify the academic timeframe for which you are requesting information.
2020-2021
2019-2020
2018-2019
2017-2018
Section 4: Delivery (for student and/or parent release only)
Mail the information to the home/primary address on
file.
Section 5: Student Certificaton
I hereby give my permission to Wright State University’s Office of Financial Aid to release the information specified above. I release Wright
State University from any liabliity which might result from the requested information being released.
Student Signature
Date
CSROI – Rel of Info Request
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Release Of Information Request Form ODD (Wright State University)

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Completed 16 December 2020

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