Fillable Student Authorization to Release Records (Gogebic Community College)

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Student Authorization to Release Records (Gogebic Community College)

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Revised May 2015
Student Authorization to Release Records
POLICY REGARDING RELEASE OF STUDENT RECORDS TO PARENTS
Student Release. Students may authorize the College to
release private student records and academic information
to indicated people upon that person’s request. Students
who desire this service need to complete this form and file
it with the Vice President of Student Services Office. This
authorization is voluntary. This authorization will remain
in effect until the student provides written notice to the
Vice President of Student Services terminating the service.
Parental Release. According to the Family Education
Rights and Privacy Act of 1974 (FERPA), as amended, the
College may provide to parents or legal guardians of
dependent students information regarding academic
progress and disciplinary action without student consent.
Status as a dependent is determined by the Internal
Revenue Code of 1986, Section 152. In accordance with
FERPA, parents or guardians who wish to receive such
information without student consent must make written
request to the Registrar and provide evidence that the
parents or guardians declared the student as a dependent on
their most recent Federal Income Tax Form. Gogebic
Community College does not release any educational
information to parents without a signed student release
indicating consent.
AUTHORIZATION TO BE COMPLETED BY THE STUDENT:
I, the undersigned student, do hereby request that any information concerning me be released to the person(s) named below upon their
request. My signature authorizes the College to release information about me during the period in which I am enrolled at the College.
I understand I have the right to terminate this authorization by providing written notice to the Vice President of Student Services.
Print Student Name ________________________________________ GCC Student ID_______________________
Student Signature __________________________________________ Date _______________________________
Provide student information to:
PRINT Name & Address of/Contact 1: PRINT Name & Address of Contact 2:
Contact 1 Name __________________________________ Contact 2 Name ____________________________________
Address __________________________________ Address ____________________________________
City, State, ZIP __________________________________ City, State, ZIP ____________________________________
Telephone __________________________________ Telephone ____________________________________
Relationship __________________________________ Relationship ____________________________________
Please check which box of data you are authorizing us to release to the name(s) listed above:
Financial Data Student Data Both Financial and Student Data
NOTICE: Authorization becomes valid when filed in the Vice President of Student Services Office and stays
in effect while you are a current student at GCC – return by email to monicar@gogebic.edu
Revised May 2015
Notification of Rights under FERPA for
Gogebic Community College
The Family Educational Rights and Privacy Act (FERPA) affords students certain rights with respect to their
education records. These rights include:
1. The right to inspect and review the student's education records within 45 days of the day the College receives a
request for access. A student should submit to the Vice President of Student Services, a written request that
identifies the record(s) the student wishes to inspect. The College official will make arrangements for access
and notify the student of the time and place where the records may be inspected. If the records are not
maintained by the College official to whom the request was submitted, that official shall advise the student of
the correct official to whom the request should be addressed.
2. The right to request the amendment of the student's education records that the student believes are inaccurate,
misleading or otherwise in violation of the student's privacy rights under FERPA. A student who wishes to ask
the College to amend a record should write the College official responsible for the record, clearly identify the
part of the record the student wants changed and specify why it should be changed. If the College decides not to
amend the record as requested, the College will notify the student in writing of the decision and the student's
right to a hearing regarding the request for amendment. Additional information regarding the hearing
procedures will be provided to the student when notified of the right to a hearing.
3. The right to provide written consent before the College discloses personally identifiable information from the
student's education records, except to the extent that FERPA authorizes disclosure without consent. The College
discloses education records without a student's prior written consent under the FERPA exception for disclosure
to school officials with legitimate educational interests. A school official is a person employed by the College in
an administrative, supervisory, academic or research, or support staff position (including law enforcement unit
personnel and health staff); a person or company with whom the College has contracted as its agent to provide a
service instead of using College employees or officials (such as an attorney, auditor or collection agent); a
person serving on the Board of Trustees; or a student serving on an official committee, such as a disciplinary or
grievance committee, or assisting another school official in performing his or her tasks. A school official has a
legitimate educational interest if the official needs to review an education record in order to fulfill his or her
professional responsibilities for the College.
4. The right to file a complaint with the U.S. Department of Education concerning alleged failures by the College
to comply with the requirements of FERPA. The name and address of the Office that administers FERPA is:
Family Policy Compliance Office
U.S. Department of Education
400 Maryland Avenue, SW
Washington, DC 20202-5901
Revised May 2015
Notification of Rights under FERPA for
Gogebic Community College
The confidentiality of students’ educational records is protected by the Family Educational Rights and Privacy
Act (FERPA), a federal law. FERPA allows the College to release student “directory information” without a
student’s consent, unless the student has requested in writing that such information be kept confidential.
Gogebic Community College defines “directory information” as the following:
The most common way in which Gogebic Community College releases student directory information is:
Through the enrollment verification process of the Vice President of Student Services Office or similar offices that have
access to student records. The verification process verifies that a student is enrolled at the College by potential employers,
credit agencies, insurance companies, lending agencies, and others. Directory information as defined above may be made
available through other offices with access to student records upon similar request.
Gogebic Community College offers students the option to keep all directory information confidential. However,
please be advised that doing so will make this important information unavailable to all, including prospective
employers, credit agencies, and others to whom you may want this information known. Thus it is recommended
that students carefully consider whether personal privacy concerns outweigh the potential inconvenience of having
directory information withheld.
Student name, addresses, telephone numbers, major and/or minor field(s) of study, photos,
participation in officially recognized activities/sports, dates of attendance, current credit load, full
or part time status, awards and honors awarded, degree(s) awarded, dates that degree(s) or honor(s)
were awarded.
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Student Authorization to Release Records (Gogebic Community College)

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Completed 26 July 2020

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