Revised: January 2017 Office of Records & Registration
STUDENT INFORMATION RELEASE AUTHORIZATION
____________________________________________ _______________________________________
Name (Last, First, Middle Initial) GGU ID# or SS# (Last 4 Digits Only)
_______________________________________ ___________________________________
Email Address Daytime Phone
_______________________________________ ___________________________________
Name (Last, First, Middle Initial) Relationship to Student
_______________________________________ ___________________________________
Email Address Daytime Phone
________________________________________________________________________________
Current Address
________________________________________________________________________________
Purpose of Release
Type of Information to be Released (Check one or more boxes below):
Academic Student Account Financial Aid All Other _____________________
In accordance with The Family Education Rights and Privacy Act (FERPA) of 1974, Golden Gate
University will only disclose confidential information from the education records of students to parents,
spouses, sponsors, or other third parties provided the University has written consent from the student
on file. Please note: This release form will remain valid through the student’s enrollment at Golden Gate
University unless specifically revoked by this student.
By signing below, I consent that Golden Gate University may disclose and discuss confidential
information from my education record with the individual listed above in reference to the purpose of
release as indicated above:
_______________________________________ ____________________________________
Student’s Signature Date
Relevant offices indicated above have been notified by: ___________________ Date: _____________
Complete, scan, and submit this form to the Office of Records & Registration at records@ggu.edu
or fax to 415-442-7223. For questions or assistance call 415-442-7292. This form applies to
university and Law School students.
click to sign
signature
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