FERPA: Authorization for Release of Information

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Release*

Please list the name, address (street, city, state, zip) and phone number of the person receiving the information.

Please provide a 5-digit PIN number. The person that will be receiving the information must have access to the PIN number. The Office of the Registrar will not release information without the PIN.

Valid For*

Please list the details of the one time use. Example: Can only be used for Fall 2021 grades.

I understand that some of my records may be protected under the Family Educational Right and Privacy Act of 1974 and cannot be released without my written consent. I hereby waive all provisions of the law and privilege relating to the records described in this disclosure. I certify that this consent has been given freely and voluntarily. I may revoke this consent at any time by providing written notice of such revocation to the Office of the Registrar.