University College Use Only
Received on:
STUDENT CONSENT TO RELEASE
EDUCATIONAL RECORDS UNDER FERPA
University College | Hoggard Hall, 172 | 910.962.3245 | uc@uncw.edu
PLEASE PRINT
Name of Student:
_________________________________________________ Student Banner ID:
Date of Birth:
Cell Phone Number:
I, the undersigned, hereby authorize University College to release my educational records such as
grades, course schedules, advising, and academic standing, to the following parents and/or guardians:
Name:
Relationship to Student:
Phone Number:
Address:
Name:
Relationship to Student:
Phone Number:
Address:
I understand that (1) I have the right not to consent to the release of my educational records,
information and works; (2) I have the right to receive a copy of such records upon request; (3) and
that this consent shall remain in effect until revoked by me, in writing and delivered to UNCW,
but that any revocation shall not affect disclosures previously made by UNCW prior to the receipt
of any such written revocation.
Student signature
Date
Confidentiality and Student Privacy: Using FERPA
The Family Educational Rights and Privacy Act (FERPA) protects the disclosure of student information to individuals
other than
University officials with “need to know” and those to whom the student has given access. FERPA
prohibits University
College Academic Advisors from releasing information about a student’s academic standing to
parents without the permission of
the student.
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