The Family Educational Rights and Privacy Act (FERPA) of 1974 is designated to protect the privacy of educational records, to establish the
rights of students to inspect and review the educational records, and to provide guidelines for the correction of inaccurate or misleading
data through informal and formal hearings. WCC’s procedures for complying with the provisions of this act can be found at wccnet.edu/
start-now/apply/ferpa. In accordance with FERPA, the College may not discuss your academic and/or financial information with your
parents, spouse or guardian.
By completing and signing this form, you authorize WCC to discuss your information with your designee (parent, spouse, partner,
relative, guardian, etc.). You should give great consideration to this before choosing to exercise this option and submitting this form. By
signing this form, College personnel may disclose any information pertaining to your records that you have authorized. This
authorization will remain in effect until you submit written notice terminating this consent to Student Connec
tion.
Your designee will need to know the PIN that you create in order for us to release your information indicated below.
Release of Information Form
Washtenaw Community College - Office of Student Records
Last updated: February 2020
Student ID: @00
Name:
STUDENT AUTHORIZATION (Check and initial all that apply):
All Financial Aid Records (records including but not limited to: status of file, amounts of financial aid
awarded and disbursed, Satisfactory Academic Progress status, income information, or any other
information contained in the financial aid file).
All Academic/Transcript Records (records including but not limited to: transcripts, registration and
schedule information, residency information, Satisfactory Academic Progress status, assessment
test scores, and any other documentation contained in the academic records).
All Student Finance Records (records including but not limited to: nature of, amounts due, payments
received and sources of payment for all student account charges; sources of, balances due and
payments made to students relative to refunds, grants, scholarships, loans, and sponsors; all
account payment plans; all financial holds on student accounts and records, including those related
to student account balances due and/or in collection and financial aid adjustments).
RELEASE INFORMATION TO:
CANCEL RELEASE TO:
FULL NAME (FIRST, MI, LAST)
RELATIONSHIP TO STUDENT
FULL NAME (FIRST, MI, LAST)
RELATIONSHIP TO STUDENT
FULL NAME (FIRST, MI, LAST)
RELATIONSHIP TO STUDENT
Submit this form in person at the Student Connection. If you are unable to submit
this form in person, you must have your signature notarized and mail to:
SIGNATURE
DATE
OFFICE USE ONLY
RECEIVED BY:
DATE:
CREATE
ONE 4
DIGIT
PIN
CHECKED
STUDENT ID
SIGNATURE:
DATE:
Washtenaw Community College
Student Connection
4800 E. Huron River Drive
Ann Arbor, MI
48105
4800 East Huron River Drive, Ann Arbor, Michi
gan 48105-4800 • 734.973.3300 wccnet.edu
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome