Family Educational Rights & Privacy Act – FERPA – Release of Information My Name First Middle Last Last 4 digits of my SSN Birthdate* MM slash DD slash YYYY My Email* Permission Granted* I do not grant permission for any individual to view any of my educational records I 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.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.HiddenIndividuals to whom information indicated above can be released:Individual 1: Name First Last Individual 1: Relationship Individual 1: Date of Birth 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? Yes No Individual 2: Name First Last Individual 2: Relationship Individual 2: Date of Birth 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? Yes No Individual 3: Name First Last Individual 3: Relationship Individual 3: Date of Birth MM slash DD slash YYYY Individual 3: Last 4 digits of SS # Individual 3: Email
