Request to Release Personally Identifiable & Confidential Information
______________________________________ _____________________________ _________________
Last Name First Name EMPLID #
I would like to obtain and review copies of my financial aid records listed below. (e.g. Financial Aid Awarded
for the Fall 2019 Semester-PLEASE BE SPECIFIC)
Note: I understand that I will not have access to my parents’ financial records without their express written
consent. [See the Request to Release Parental Financial Information Form if parental information is required.]
_________________________________________________________________________________________
_________________________________________________________________________________________
Release Authorization
Under Federal Legislation, namely the Family Educational Rights & Privacy Act of 1974 (FERPA), and the City University of
New York policy, I understand that my student aid records cannot be released to a third party without my express written
consent. I hereby authorize the Office of Financial Aid at Kingsborough Community College (KBCC) to release information
from my student aid records to the agency or individual named above.
PLEASE CHECK ALL THAT APPLY:
I will pick up the requested information
Please mail the information to my address on file
I
hereby waive my rights under the FERPA by authorizing KBCC to share any requested information concerning my financial aid
application, awards, and other “non-directory” information.
******
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***ADMINISTRATIVE USE ONLY***
Information Picked up by Student
Information mailed or faxed
Permission to Release Information to:
__________________________________________________________________
Financial Aid Officer’s Signature
Student’s ID#: __________________________________
