Authorization To Release Information Ferpa Release Form
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1Authorization to Release Information
FERPA Release Form
Student Name (Please Print)
Clemson ID#
At Clemson University, we strive to protect the identity and information unique to you, the student. In accordance with the
Family Educational Rights and Privacy Act of 1974 (FERPA), Clemson University students are allowed to disclose information only
to those people identified by the student. The undersigned student hereby permits Clemson University to disclose the
information specified below to the individuals listed in this document.
_____ I am the only person authorized to access my financial aid information.
Name (First, M.I., Last):
Last 4 of SS#:
Relationship to Student:
Name (First, M.I., Last):
Last 4 of SS#:
Relationship to Student:
Name (First, M.I., Last):
Last 4 of SS#:
Relationship to Student:
Name (First, M.I., Last):
Last 4 of SS#:
Relationship to Student:
What will be disclosed?
All Financial Aid Records (records include: status of file, award and disbursement of funds information, Satisfactory Academic
Progress status, income information, and any other information contained in the financial aid application, FAFSA or financial aid
file).
I understand the information may be released orally or in the form of copies of written records, as preferred by the requester.
This authorization will remain in effect from the date it is executed until revoked or updated by me, in writing, and delivered
to the Department(s) identified above or upon my graduation from the University, whichever comes first. Please allow 5
NO FAX OR MAIL SUBMISSIONS WILL BE ACCEPTED. EMAILS ACCEPTED
business days for processing.
ONLY FROM CLEMSON STUDENT EMAIL ADDRESS.
Student Signature (digital signatures not accepted)
Date
Clemson University Office of Student Financial Aid
FERPA.pdf
6/2/2016
G01 Sikes Hall Clemson, SC 29634-5123
Phone: 864-656-2280 Email: finaid@clemson.edu
Emails accepted only from Clemson student email address
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