Ferpa Release Form - Umuc
ADVERTISEMENT
1FERPA RELEASE FORM
Mailing address:
3501 University Boulevard East Adelphi, MD 20783-8070
Main line 240-684-2288
Fax 240-684-2001
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law
that protects the privacy of student education records. The law applies to all schools that receive funds under an
applicable program of the U.S. Department of Education.
In accordance with FERPA, it is UMUC’s policy to withhold certain educational records unless the student pro-
vides consent to disclose information. The purpose of this form is to provide the consent to UMUC required by
FERPA.
I, the undersigned, hereby authorize the University of Maryland University College to release/discuss the speci-
fied educational records and information:
:
Educational Records and Information
[Please check all that apply]
Review of all Educational Records
Financial Aid Records
Grades for the academic year
Billing, Payments, Student Accounts Records
Official Transfer Credit Evaluation/Degree Pro-
Military/Active Duty Records
Veterans Records
gress Report
Other:___________________________________________________________________________________
___________________________________________________________________________________________
To: ____________________________________
Relationship: ___________________________________
[Please print name]
[Please print relationship]
:
For the purpose of
Handling my educational matters
Handling my Department of Veterans Affairs Educational Benefits
Other: ____________________________________________________________________________
_____________________________________________________________________________
This release does not permit the disclosure of these records to any other persons or entities without my written
consent or as permitted by law. This release form is effective ______________ to _________________.
Day/Month/Year
Day/Month/Year
___________________________________________
____________________________________
Student’s Signature
Student’s Name (Please Print)
Date
________________________________________
____________________
Signature of Parent or Guardian (if the student is under the age of 18)
Student Identification #
[
6/7/11]
SA FERPA RELEASE FORM
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal