Fillable This Form replaces ALL previous PI TT COMMUNITY (Pitt Community College)

Fill Online, Printable, Fillable, Blank This Form replaces ALL previous PI TT COMMUNITY (Pitt Community College) Form

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This Form replaces ALL previous PI TT COMMUNITY (Pitt Community College)

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The This Form replaces ALL previous PI TT COMMUNITY (Pitt Community College) form is 1 page long and contains:

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  • 9 check-boxes
  • 10 other fields

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File type: PDF

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PI
TT COMMUNITY COLLEGE
FERPA RELEASE FORM
WH
AT IS FERPA?
In
general, the Family Educational Rights and Privacy Act of 1974 prohibits the access and release of student
educational records without the student’s written consent if the student is 18 years or older. By signing this form,
the student allows Pitt Community College to release records to parents, and/or grandparents, and/or spouses,
and/or guardians, and/or others.
I, (print or type full name) the undersigned,
hereby authorize Pitt Community College to release the following educational records upon request to the
designated individuals or entity below (check all that apply):
All financial records
Academic records/transcripts
Student conduct records
Other educational records (please specify):
PCC ID No.: SS No. only if PCC ID No. is not available:
I understand that if I am under 18 years old or a dependent for tax purposes, Pitt Community College can release
educational records to parents and legal guardians regardless of my consent.
Student’s Signature (required) Date
Designated Individuals/Entities:
Name:
Address 1:
City/State/Zip:
Phone/Cell:
Relationship (check one):
Parent Grandparent Guardian Spouse Other
Return Signed
FERPA Release (Via student's mypittcc email only) to: Registrar@my.pittcc.edu
No other email address will be accepted
NOTICE
This Form replaces ALL previous
FERPA forms on file.
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This Form replaces ALL previous PI TT COMMUNITY (Pitt Community College)

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Completed 1 October 2020

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