ENROLLMENT SERVICES
RELEASE OF STUDENT INFORMATION
This release form is valid only in the department for which it is signed below. A separate release form is required in other
campus departments (i.e. Enrollment Services, Financial Aid, Career and Advising, instructional divisions, etc.).
Family Educational Rights and Privacy Act of 1974 (FERPA)
Green River College student educational records are maintained according to the Family Educational Rights and Privacy
Act of 1974 (FERPA). As provided by FERPA, whenever a student is attending an institution of postsecondary education
(regardless of age or dependent status) the permission or consent required of and the rights accorded to the parents shall
thereafter only be required of and accorded to the student.
Release of Information- -- Students must sign a release in order to have their educational records released to third parties
or to authorize third parties to conduct registration activities/transactions on behalf of the student. Information may be
released to a third party without student’s consent if 1) information is requested officially by means of a subpoena, court
order or legal report or 2) information is designated ‘‘directory information.’’ Additionally, Congress requires student
information to be released to military recruiters if officially requested.
Ref: 20 U.S.C. 1232g, TITLE 20 - - Education, Chapter 31, Part 4, Section 1232g, subsection (7), (d)
STUDENT INFORMATION
Green River SID:
I, ,
Student’s full legl name
give permission to
Campus department
to release my educational records to ,
Name of third party or parties
for the period of and as indicated: ❑ Indefinitely or until rescinded by me in writing.
❑ Start date: To end date:
❑ Other. Be specific:
SIGNATURE
❑
I further understand that I may rescind my permission at any time and may do so only in writing.
Student: Date:
ES1508ReleaseStdntInfo
1 of 1
OFFICE
USE
ONL
Y
Date: Processed by:
This document is available in alternative formats to individuals with disabilities by contacting Disability Support Services at 253-833-9111, ext. 2631; TTY 253-288-3359; or by email at dss@greenriver.edu.
Green River College is an equal opportunity educator and employer. Learn more at www.greenriver.edu/accessibility.
greenriver.edu/enrollment • (253) 833-9111 Ext. 2500 • 12401 SE 320th St., Auburn, WA 98092
enrollmentservices@greenriver.edu • fax (253) 288-3454
