Student Release of Information (FERPA) Form
Name: Student ID #:
I give permission to release any information related to my attendance and/or academic
performance in any VGCC class to: (Please include full name(s) and relationship to student.)
Release Information to (Person's Name):
Relationship to Student:
Contact Information (Email or Telephone):
Types of Information to Release (check all that apply)
All Records
Accounting-Includes tuition and fee balances, financial holds, mailing and billing
address, payment plans, accounting statements and collections and debt information.
Admission-Includes dates of application, programs selected, documents received,
documents pending, dates of admission, admission status and conditions of admission.
Registration-Includes current enrollment, dates of enrollment activity, enrollment
status, residency status, semesters attended and mailing address information.
Academic-Includes courses taken, grades received, GPA, academic progress, honors,
transfer credit awarded and degree(s) awarded.
Financial Aid-Includes all general financial aid information.
This request is valid for the duration of my attendance at Vance-Granville Community College,
and may only be rescinded in person or in writing with photo I.D.
I understand that this form requires notification of all parties if rescinded.
Signature __________________________________
Date____________________
Release of Information: Family Educational Rights & Privacy Act (FERPA)
Vance-Granville Community College, in compliance with the Family Education Rights and Privacy Act of 1974,
releases no personal, identifiable information about students without the written approval from the student.
Exceptions to this practice are those types of information defined by law as “directory information.”
VGCC defines the following as directory:
*Name *Program of Study *Degrees and awards received
*Dates of Enrollment *E-mail addresses *Participation in sanctioned campus activities or athletics
The directory information may be published or made available without the consent of the student. However, any
student not wishing any of these types of information released may request in writing to the Registrar's Office
that it not be released. See the Admissions, Registration & Records section of the VGCC Student Catalog for
additional information.
1
Student Release of Information Form
Revised Date: 3/22/17/ASA
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