Family Educational Rights & Privacy Act – FERPA – Release of Information My Name First Middle Last Last 4 digits of my SSNMy Email* Permission Granted*I do not grant permission for any individual to view any of my educational recordsI do grant permission for the following educational records to be viewed.The individual(s) listed on this document will have my permission to view the following records. Financial Aid information Financial information (bills to be paid or refunds due) Grade information Housing information To ensure your form is processed in a timely manner, please be sure to complete and submit the signature page that follows.Individuals to whom information indicated above can be released:Individual 1: Name First Last Individual 1: RelationshipIndividual 1: Date of Birth Date Format: MM slash DD slash YYYY Individual 1: Last 4 digits of SS #Individual 1: Email 1: Would you like to include another to whom information indicated above can be released?YesNoIndividual 2: Name First Last Individual 2: RelationshipIndividual 2: Date of Birth Date Format: MM slash DD slash YYYY Individual 2: Last 4 digits of SS #Individual 2: Email 2: Would you like to include another to whom information indicated above can be released?YesNoIndividual 3: Name First Last Individual 3: RelationshipIndividual 3: Date of Birth Date Format: MM slash DD slash YYYY Individual 3: Last 4 digits of SS #Individual 3: Email
