Release Authorization
PLEASE RETURN THIS FORM TO ANY OF THE OFFICES LISTED BELOW.
In accordance with the Family Education Rights and Privacy Act (FERPA) of 1974 as amended, students must provide
written consent if they would like Chapman University to share information with parents, spouses, or any other person
or groups of persons.
By completing and submitting this form, you are authorizing Chapman University personnel to discuss the details of your
University application, accounts, and records with whomever you designate. This authorization will remain in effect
until revoked in writing.
______________
STUDENT NAME STUDENT ID NUMBER
For each party listed below, I would like this release to apply to the office(s) checked.
Financial Business Registrar’s Office
Aid Services Records to be released:
NAME _________________________________
NAME ________________________________
Please submit via Chapman Student Email or in person to one of the offices below.
Financial Aid Office Email: Undergraduate finaid@chapman.edu Graduate Email: gradfinaid@chapman.edu
I hereby authorize the release and/or discussion of information regardin
g my
application, eligibility, financial aid award.
Student Business Services Office Email: ocbusn@chapman.edu
I hereby authorize the release and/or discussion of information regarding my student account including, but not limited to: charges,
payments made and/or due on my account.
Office of the Registrar Email: registrar@chapman.edu Law School Registrar Email: lawregistrar@chapman.edu
I hereby authorize the release and/or discussion of information regarding any of my educational records.
I understand that each office is responsible for discussing information only related to records/functions for which it is responsible. The
submission of this form voids all previously submitted release forms, so please list every person(s) to whom you are allowing Chapman University
to release information.
______________________________________
STUDENT’S SIGNATURE DATE
Release or transfer of the above information to any other person or organization is prohibited. An additional written consent must be obtained if
any of the information is to be transferred to another person or organization. This form must be completed in full before information can be
released. Copies of this form should be retained by all individuals whose names appear above.
Any Educational Record
NAME ________________________________
Requested
RLFYE
Residence Life and First Year Experience Email: reslife@chapman.edu I hereby authorize the release and/or discussion of
information regarding my student housing including but not limited to my application, lease, eligibility, and room assignment.
