Indiana Tech Non-Directory Information Release Form
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2INDIANA TECH
NON-DIRECTORY INFORMATION RELEASE FORM
• In accordance with the Family Educational Rights and Privacy Act (FERPA) and Indiana Tech
policies, this form allows students to grant third party access to parents, guardians, spouse, and/or others
to their educational and financial records maintained by the Office of Admissions, Registrar’s Office,
Business Office and the Financial Aid Office.
• Students may not select subsections of academic records to be released. In other words, a student may
not give access to billing information, but not to grades. This release will cover all non-directory
information. University individuals may choose to not release information without obtaining specific
student permission. Release of information is not required by law.
• A transcript request form with the student’s signature is required for official transcripts.
• All permissions granted will stay in effect until revoked in writing by the student.
• See back of page for definition of FERPA, Directory and Non-Directory Information
PLEASE PRINT CLEARLY
I give permission for the following person(s) to have access to my educational/financial records.
Release
Cancel release
Relationship: Parent Guardian Spouse Other____________________
Name: _________________________________________________________________________________________
Address: ________________________________________________________________________________________
City: __________________________________ State: ______________ Zip Code: ____________________________
Primary Phone: _______________________________Secondary Phone: ___________________________________
Circle one: Home
Business
Cell
Other
Circle one: Home
Business
Cell Other
E-Mail Address: __________________________________________________________________________________
Release
Cancel release
Relationship: Parent Guardian Spouse Other____________________
Name: _________________________________________________________________________________________
Address: ________________________________________________________________________________________
City: __________________________________ State: ______________ Zip Code: ____________________________
Primary Phone: _______________________________Secondary Phone: ___________________________________
Circle one: Home
Business
Cell
Other
Circle one: Home
Business
Cell Other
E-Mail Address: __________________________________________________________________________________
I do not wish to allow third party access to non-directory information.
_____________________________________
_________________
___________
Print Full Name
Student ID or SSN#
Birth Date
_____________________________________
_____________________
Student Signature
Date
Please return this form to Registrar’s office.
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