Ferpa Release Form - College Of The Albemarle


FERPA Release Form
In general, the Family Education Rights and Privacy Act of 1974 (FERPA) prohibits access and
release of a college student’s educational records without the student’s written consent. By
signing this form, the student allows the College of The Albemarle to release information to
parents, grandparents, spouses, guardians, and others as designated.
I, _______________________ the undersigned, hereby authorize College of The Albemarle to
release the following educational records upon request to the designated individuals or entity
below (check all that apply):
All Financial Records (including Financial Aid)
Financial Aid Award Year____________________
Academic Records/Transcripts
Student Conduct Records
Other Educational Records (please specify): ____________
Please complete the following information. This form is only good for one academic year.
Student signature (required) ___________________________ Date ____________
COA ID Number ____________________ or Last four digits of SSN ________
Designated Individual
Name _______________________________________________________
Address _____________________________________________________
Relationship to student ________________________________________
Return signed FERPA release to:
College of The Albemarle
ATTN: Registrar
PO Box 2327
Elizabeth City, NC 27906-2327


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