Student Consent For Release Of Education Records Information printable pdf download

This form also can be completed and updated via your PAWS account.

STUDENT CONSENT FOR RELEASE OF EDUCATION RECORDS INFORMATION

Name of Student (Last, First, Middle Initial):

Student ID:

Date:

The Family Education Rights and Privacy Act (FERPA) affords certain rights to students concerning the privacy of, and access to, their education

records. Students may choose to complete and submit this form to allow the release of their education records to specified third parties. Please note

that while this form authorizes the University of Wisconsin – Milwaukee (UWM) to release education records to third parties, it does not obligate

UWM to do so. UWM reserves the right to review and respond to requests for release of education records on a case-by-case basis. For additional

information on FERPA, visit the U.S. Department of Education’s website at:

SECTION A. Duration of Release:

__________________ to ____________________

Until Revoked

(Date)

______________________________________________________________________________________________________

SECTION B. Education records to be released (check all that apply):

Academic Information

Financial Information

Other Information

All Academic Information

All Financial Information

Academic Misconduct

Specify Term(s) ______________

Student Billing and Accounts

Non-Academic Misconduct

Grades/GPA

Specify Term(s) ______________

Financial Aid

University Housing Behavior/Conduct

Class Schedule

Housing Account Status

University Housing Contract Termination

Specify Term(s) ______________

Housing Account Activity Report

University Housing Residency Status

Enrollment Status

Specify Term(s) ______________

Meal Plan Report

Other (please specify):

SECTION C. Person to whom access to education records may be provided (use additional forms if necessary):

___________________________________________

_______________ _______________________________________

Name(s) of person(s) to whom access to records may be provided

Relationship to Student

Address of person(s)

SECTION D. Purpose of release (check one):

Other (please specify):

Admission to an Education Institution

Employment

Family

I understand that (1) I have the right not to consent to the release of my education records, (2) I have the right to inspect any written records released

pursuant to this consent, (3) I have the right to revoke this consent at any time by delivering a written revocation to the Registrar’s Office, and (4) I

understand that I can also obtain a copy of the above indicated records if I desire.

Student's Signature

Date

Notary required if mailed: Subscribed and sworn to before me by ___________________________ this _________ day of ______________, ________.

My commission expires: ____________________________.

_________________________________________________

Notary Public [A]

State of ______________________________

Submit completed form to the any of the following offices:

Bursar’s Office

Department of Financial Aid

Registrar’s Office