Ferpa Release Form - Rutgers Financial Aid
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1FERPA
FERPA Release Form
The Family Educational Rights and Privacy Act (FERPA) is a federal law that gives students in higher education various rights with
respect to their education records. Rutgers may not disclose personally identifiable information from your records to anyone outside of
the university without your prior written consent. You may use this form to authorize the university to release your student records to
third parties, including parents and/or guardians. However, completion of the form must be witnessed by either a notary public or an
authorized representative of the university.
I, __________________________________________________________________________ , hereby authorize the Office of Financial Aid
(Student name, printed)
to disclose, make accessible, and furnish the following information upon request:
Official Transcript
Financial Aid Record(s)
Judicial Affairs File(s) (College or University)
Student Accounts Information
Deans of Students Office File(s)
Residence Life File(s)
Other (Description:
__________________________________________ )
All of my records
to __________________________________________ at _____________________________________________________________________________
(To whom records are to be released)
(Address)
These records will be used for the purpose of ______________________________________________________________________________________
This release shall be effective until
__________________________________ unless revoked in writing by me.
Signatures
___________________________________________________________
_______________________________________________________________
RUID or A number
Student signature
Date
Notary’s Certificate of Acknowledgment
(This section is only required if the student is not signing the form in the presence of the Office of Financial Aid staff - Proper ID is required.)
State of _______________________________________________________________________________________________________________________
City / County of ________________________________________________________________________________________________________________
On _____________________________ , before me, _________________________________________________________________________________
(Date)
(Notary’s name)
personally appeared, ____________________________________________________________________________________ , and provided to me
(Printed name of signer)
on basis of satisfactory evidence of identification ___________________________________________________________________________________
(Type of government-issued ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal:
_____________________________________________________
(Notary signature)
My commission expires on ____________________________
Office of Financial Aid Witness:
__________________________________________________________________________________________________________
Print name
Signature
Date
Return this form to your regional Office of Financial Aid.
For office hours and locations, visit:
financialaid.rutgers.edu/contact
For internal use only: this form is valid for AY 16/17 and 17/18
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