Admissions & Records
Authorization for Release of Student Records Form
In accordance with the Family Education Rights and Privacy Act (FERPA)
Subject to certain exceptions set forth in the Federal Family Education Rights and Privacy Act (FERPA) of 1974, Solano Community College
will not provide personally identifiable student information (including but not limited to grades, billing, tuition/fees assessments, financial aid and
other student records) to third parties absent the student's consent. Third parties include parents, spouses and third-party designees.
Students may grant Solano Community College permission to release certain information to a third party by submitting this form. A separate
form must be submitted for each individual request to grant access to your records. Records will only be released upon request by the third party
(they will not be sent automatically by Solano Community College).
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Grades/GPA, registration, academic performance/standing, class schedule, transcripts and/or enrollment information
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Financial aid awards, application data, disbursements, eligibility and/or financial aid satisfactory academic progress
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Finance-related records, including billing statements, charges, credits, payments and past due amounts
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Other (Please specify):
The third-party individual or agency will be asked to provide the following personal security password:
This consent shall remain in effect through (choose one):
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Entire duration of enrollment with Solano Community College
□
Academic Year (Please specify):
I understand that although I am not required to release this information, I am giving my consent to Solano Community College to
disclose these records.
Student Initial
This authorization shall stay in effect for the current academic year only. (To revoke a Student Information Release submit a written
request)
Students and the third-party individual listed above must sign the form in the presence of a college official and show a photo ID. Please submit
to the Office of Admissions and Records on the Fairfield Main Campus, the Vacaville Center, Vallejo Center, or Travis Air Force Base office.
STUDENT SIGNATURE DATE
Verified ID/s: Yes No Received by: Date:
Paperclip: Yes No Processed by: Date:
Student Information
STUDENT’S NAME STUDENT ID NUMBER
MAILING ADDRESS
STREET
CITY
STATE
ZIP
PHONE NUMBER
Third-party Designee
NAME
FIRST & LAST
or AGENCY and RELATION TO STUDENT PHONE NUMBER
ADDRESS
STREET
CITY
STATE
ZIP
EMAIL ADDRESS
Information Types Allowed (Check one or more of the boxes below to grant authorization):
Certification
Office Use Only:
Student Initial
Summer 20______
Fall 20______
Spring 20______
click to sign
signature
click to edit
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