STUDENT RECORDS ACCESS/RELEASE
REQUEST FORM
(FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974)
I ______________________________, hereby request permission to review my personal records on
(print full name)
file at the College as follows:
Please indicate the specific records you wish to access, i.e., transcript, grade reports, etc. (All or any
of the above).
Comments:
________________________________________________________________________________
________________________________________________________________________________
I give permission to Union County College to release my records to my parent(s), legal guardian, or
outside agencies or institutions as appropriate. Please print name(s) below and any special instructions.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
__________________________________________ ________________
Student’s Signature Date
__________________________________________
Social Security Number
__________________________________________
Approximate Dates of Attendance
SPECIAL NOTATION
The College is legally granted a grace period of 45 days in which to comply with requests for student access to
records. Union County College will make every effort to expedite all requests within a reasonable time period. Stu-
dents should also be reminded that the following information is exempt from review by students:
A. Confidential letters of recommendation.
B. Personal notes of instructors and administrators which are retained in their possession.
C. Medical and Mental Health information.
D. Parent’s Financial Statements (PCS Forms).
__________________________________________ ________________
Authorized College Official Signature Date
Union County College does not discriminate and prohibits discrimination, as required by state and/or federal law, in all programs and activities,
including employment and access to its career and technical programs.
R-6.2020
