Office of Admissions and Records
University of Nevada, Reno, 1664 N. Virginia Street, Office of Admissions & Records, MS 0120, Reno, NV, 89557 - 775-784-4700
Student Authorization to Release Information
The University does not allow access to, or the release of, educational records or other personally identifiable information without
written consent of the student. (Exception: the University must disclose information to students requesting review of their own
records and to authorized government official or agencies for audit and evaluation of state and federally funded programs as
stated in the Federal Education Right to Privacy Act.)
Student Information:
Name
NSHE ID
Phone
( )
E-Mail Address
Check the one that applies:
Dependent: If you are a dependent student as defined by federal financial aid definitions, we will only disclose
information to your "parent of record." Your "parent record" is the parent(s) whose information is on your FAFSA.
If you are an independent student by federal financial aid definitions, we will only disclose your information to you
and the person whom you list below.
Authorized Person Information:
By signing below and supplying confidential information as an identifier, I authorize the University of Nevada, Reno to release
information from my University records to the following person:
Name
For Office Use Only
Evaluator Date
Approved
Denied
Relationship to Student
Phone Pass Phrase
This authorization applies to all information regarding my (check one or both):
Financial Aid and Scholarships
Cashier's/Student Accounts
Admissions and Records
This authorization is in effect until the end of the academic year during which it was issued or I request in writing that it be
rescinded, whichever comes first. In the event information is released in error, the undersigned agrees to hold the University of
Nevada, Reno harmless for damages.
PLEASE READ BEFORE SIGNING. This form must be signed: 1) in the prescence of a staff member -or- 2) if mailing this form, it must
be signed in the prescence of a Notary Public. You must submit the original document--faxes or copies will not be accepted.
Student's Signature Date
Subscribed and sworn to me: This day of , 20 . Dated this day of ,20 .
Notary Public Student Signature
)(
