Ferpa Release Form - Central Maine Community College printable pdf download

Office of the Registrar

Phone: 207-755-5292

1250 Turner St

Fax: 207-755-5495

Auburn, ME 04210-6498

Email: registrar@cmcc.edu

FERPA Release Form

The Family Educational Rights and Privacy Act (FERPA) establishes certain rights for students regarding

the privacy of their educational record. Educational records include, but are not limited to, academic,

disciplinary, financial aid, health, student account, and other information directly related to a student’s

enrollment.

While parents/guardians, spouses, or others may have an interest in the student's records, it is Central

Maine Community College’s policy to withhold certain educational records unless the student provides

written consent to disclose such information to a specific party. Students may choose to complete and

submit this "FERPA Release Form" to the Office of the Registrar to allow access or release of their

educational record. This access is for informational purposes only and does not give authority to a third-

party to make changes or request actions on the student’s educational records.

Please note that while this form authorizes CMCC to release education records to third parties, it does

not obligate CMCC to do so. CMCC reserves the right to review and respond to requests for information

on a case-by-case basis. Some information, such as grades, is not released via telephone under any

circumstances. For this information, please come to the Registrar’s Office prepared to show a photo ID.

_____________________________________________________________________________________

*A separate form must be completed for each person or entity you are giving permission to release information to.

I hereby grant permission for Central Maine Community College to release my records to the following

entity or person. (This form remains valid until student withdraws it in writing.)

Student Information:

Name:________________________________________________________________________

(Last)

(First)

(Middle)

(Previous)

Address:_______________________________________________________________________

(Number, Street, Apt/PO Box)

(City)

(State)

(Zip)

Student ID Number:_____________________________________________________________

Name and address of person/agency to receive information:

Full Name:____________________________________________________________________________

(First and Last Name and/or Organization Name)

Relationship to student: _________________________________________________________________

Address:______________________________________________________________________________

(Number, Street, Apt/PO Box)

(City)

(State)

(Zip)

I understand that I have the right not to consent to the release of my educational records, and I have the

right to revoke this consent at any time by delivering a written revocation to the CMCC Registrar.

____________________________________

_____________________________

Student’s Signature

Date

Return completed form to the Registrar’s office. Forms may be faxed or mailed in, but a copy of the

student’s photo ID with signature must be included.

Revised 7/16

Ferpa Release Form - Central Maine Community College

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