Dear Maryville University Students:
There are a number of occasions for which you may need a leer of recommendaon from a Maryville University
faculty or sta member. To provide an appropriate leer, your faculty and/or sta recommender must be free to
share informaon about you that is protected in your educaonal records covered by the Family Educaonal Rights
and Privacy Act (FERPA). To be permied to share informaon contained in your records, the aached FERPA
Release Form must be completed and signed by you, and then provided electronically to your recommender.
Please note the following records are covered by this document, although any given recommender may not be
aware of informaon contained in all of these records:
Assessment/Placement Records – test scores, and courses assigned upon entry to the university
Academic Records – transcripts, GPA, grades and aendance in any given course
Disability Records – informaon regarding a physical, emoonal, or learning disability and accommodaons
provided to facilitate student success
Financial Aid Records – specic to scholarships and/or student employment
Housing Records – on-campus living dates, locaons, leadership roles
Student Accounts – student account, payments, or nancial status (not actual amounts)
Personal Records – informaon regarding race, gender, ethnicity, and naonality
Other – feel free to specify any addional informaon you are comfortable having shared
Please note: On the FERPA Release Form (next page), the ANY of the above recordsbox is checked to allow the
recommender the greatest exibility in providing a thorough recommendaon, but feel free to uncheck that box and
choose only the records from which you agree to have informaon shared.
Feel free to print a copy of the signed form to retain for your records.
If you have any quesons, please do not hesitate to ask.
NOTE for Maryville University faculty/sta recommenders:
Please be sure you have a signed copy of this form provided to you prior to providing any leer(s) of
recommendaon on behalf of a student. You should retain the signed form in a le should quesons arise at a
later date. If you are uncertain regarding the type of informaon the form is allowing you to release, please do
not hesitate to contact us for claricaon.
Student Service Center
Gander Hall, Room 124
www.maryville.edu/ssc
ssc@maryville.edu
Phone: (314) 529-9360
Fax: (314) 529-9925
Maryville University
An: Student Service Center
650 Maryville University Drive
Saint Louis, MO 63141
Student Conduct Records - information regarding disciplinary standing and conduct policy violations
Student Service Center
Gander Hall, Room 124
www.maryville.edu/ssc
ssc@maryville.edu
Phone: (314) 529-9360
Fax: (314) 529-9925
Maryville University
An: Student Service Center
650 Maryville University Drive
Saint Louis, MO 63141
Leer of Recommendaon: FERPA Release
In order for university faculty or sta to provide leers of recommendaon which contain FERPA protected informaon you must complete
the aached form and provide an electronic copy to your recommender.
Student Name __________________________________________________________
Maryville ID Number __ __ __ __ __ __ __
Student Informaon
Individual to whom Records are to be Released
In accordance with the Family Educaonal Rights and Privacy Act of 1974, I, the undersigned, hereby authorize the individual indicated in
this secon to write a leer of recommendaon in which s/he may reference the following educaon records and informaon:
Print Writers Name
__________________________________________________________
Record types to be available
Check here to release all record areas OR check the individual record areas to which you are releasing to the
above individual
Personal Records
Academic Records
Assessment / Placement Records
Disability Records
Financial Aid Records
Scholarships
Ethnicity
Gender
Nationality
Race
Class Attendance
GPA
Grades
Transcripts
Student Employment
Housing Records
Student Account Records
Other: __________________________
Leer Recepients
Indicate the Name, Title, and address of each recipient on the lines below.
Send leers directly to these individuals OR Return leers to me in the enclosed envelope(s) with your signature across the ap.
Leer 1 ____________________________________________________________________________________________
Leer 2 ____________________________________________________________________________________________
Leer 3 ____________________________________________________________________________________________
I understand that my consent is not required for the writer to disclose in a leer of recommendaon any subjecve observaons or
assessments which s/he has of my or informaon classied as directory informaon under University Policy.
I waive my rights to review a copy of this leer of recommendaon at any me in the future
I do not waive my right to review a copy of this leer at any me
Student Signature
Signature: __________________________________________________________ Date: ____________
Student Conduct Records
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome