Ferpa Release Form - College Of The Albemarle printable pdf download

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

Ferpa Release Form - College Of The Albemarle