Student Record Access
Authorization
Student Information
Name _________________________________________________ USFID Number ______________________________
Third Party Identification and Authentication
When the people you designate below call USF, they will be asked to authenticate their identity by providing a password. You should
create a different password for each individual and provide it to them. Do not choose passwords that can be easily guessed. If the
individual is not able to correctly provide the password, USF will not release any information from your record. If you forget the
passwords, USF can only provide them to you, the student, in person or via your USF email address.
Designated Third Party
Name _____________________________________________
Relation to Student __________________________________
Address ___________________________________________
City/State/ZIP _______________________________________
Phone ____________________________________________
Password __________________________________________
Hint ______________________________________________
Designated Third Party
Name _____________________________________________
Relation to Student __________________________________
Address ___________________________________________
City/State/ZIP _______________________________________
Phone ____________________________________________
Password __________________________________________
Hint ______________________________________________
Certification
In accordance with The Family Educational Rights and Privacy Act [FERPA] of 1974, USF may only disclose confidential information
from the student records to third parties upon written consent from the student. If you submit this form, the following information,
including but not limited to, may be disclosed:
Final grades/GPA, demographic, registration, student ID number, academic progress, enrollment information, billing
statements, charges, credits and waivers, payments, past due amounts, and collection activity, application data, billing
and repayment history (including credit reporting history), communication history, balances, and collection activity.
By signing below, I consent that USF may disclose and discuss any and all confidential information from my education record with
the parties listed above. I also affirm that the parties listed above may not seek to change, amend, modify, or take action on my
student record.
Student Signature _________________________________________________________________ Date _________________________
This form may only be submitted in person by the student with photo identification at the Office of the Registrar. This form
establishes permission for USF to release any of your student record information to designated third parties (parents, spouse,
employer, etc.) Please note: This permission does not provide third parties with the ability to change, amend, modify, or take action
on your record, and USF still retains full authority to determine need to know. Once this form is submitted, it is active until you notify
the Office of the Registrar in writing to end permission. Additional forms are required for release of financial aid information and are
available in the University Scholarships and Financial Aid Services.
FOR OFFICE USE ONLY
Recipient’s Initials ____________
Processed by _____________________________________
Date Processed _______________________
Hand Delivered
& ID Checked
Office of the Registrar | 4202 E. Fowler Ave., SVC 1034 | Tampa, FL 33620 | usf.edu/studentprivacy | privacy@usf.edu
