Fillable Release of Student Information (Nashua Community College)

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Release of Student Information (Nashua Community College)

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Release of Student Information
Student’s Name: _______________________________________ ID# A ___________________
Permanent Address: __________________________________________________________________
__________________________________________________________________
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law
that protects the privacy of student education records. Under the Family Educational Rights and Privacy Act
(FERPA), Nashua Community College requires written permission from the student in order to release any
information from their education record.
I authorize disclosure of the following information to the designated persons listed below, for reasons determined by
the Nashua Community College as appropriate.
_______________ Enrollment
_______________ Attendance
_______________ Grades
_______________ Billing
_______________ Financial Aid
_______________ Other: ______________________________________________
(PLEASE SPECIFY)
________________________________________ _____________________________________
NAME (Please Print) Relationship
________________________________________ _____________________________________
NAME (Please Print) Relationship
Student Signature: ___________________________________________ Date: _____/_____/_____
This release of information does NOT allow access to the Student Information System (Student Records via the Internet)
or Official Transcripts. This release will also remain in effect until the Office of the Registrar receives a change in
writing, by the student.
OFFICE USE ONLY
Received By: ______________________ Date: __________________________
Date Entered in SPACMNT: __________ Rec’d By Registrar’s Office _________
NASHUA COMMUNITY COLLEGE
Office of the Registrar
505 Amherst Street
Nashua, NH 03063
Revised 06/06/18
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Release of Student Information (Nashua Community College)

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Completed 26 July 2020

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