Family Educational Rights & Privacy Act – FERPA – Release of Information

My Name

First Middle Last

Last 4 digits of my SSN

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.

Individuals to whom information indicated above can be released:

Individual 1: Name

First Last

Individual 1: Relationship

Individual 1: Date of Birth

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?

Individual 2: Name

First Last

Individual 2: Relationship

Individual 2: Date of Birth

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?

Individual 3: Name

First Last

Individual 3: Relationship

Individual 3: Date of Birth

Individual 3: Last 4 digits of SS #

Individual 3: Email