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THE CITY UNIVERSITY OF NEW YORK FERPA RELEASE (CUNY Kingsborough Community College)

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THE CITY UNIVERSITY OF NEW YORK
FERPA RELEASE FORM
PERMISSION FOR ACCESS TO EDUCATIONAL RECORDS
Students who wish to grant third parties, including parents, access to educational records
maintained by the student’s college should use this form, which requires a date and signature.
Electronic signatures are acceptable only if the College is able to identify and authenticate the
student as the source of the release.
The Family Educational Rights and Privacy Act (FERPA) prohibits access to, or release of,
educational records or personally identifiable information contained in such records without the
written consent of the student. This prohibition is subject to certain exceptions. For more
information about FERPA, see https://www2.cuny.edu/wp-content/uploads/sites/4/page-
assets/about/administration/offices/legal-affairs/policies-procedures/FERPA-2.pdf
Student Name (Please Print): _____________________________________________________
8-digit Student ID Number ___________________________
I, the undersigned, hereby authorize _______________________ College of The City University
of New York, to release the following educational records and information (identify records or
types of records; "all records" is not sufficient):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
These records should be released to the following person/agency (identify name and address of
person/agency to receive information):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
These records are being released for the purpose stated below:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_______________________________ ___________________________________
Student’s signature Date:
CUNY Office of the General Counsel
July 2019
ATTACHMENT B
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THE CITY UNIVERSITY OF NEW YORK FERPA RELEASE (CUNY Kingsborough Community College)

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Completed 26 July 2020

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