Ferpa Waiver Form printable pdf download

Texas A&M University-Corpus Christi

Office of the University Registrar

FERPA Waiver Form

Instructions: This form is to be used by the student to grant access to their education records to other

entities besides themselves, such as a parent, spouse, etc. When completing this form, please print all

items clearly to allow for correct processing.

The University maintains two types of student education records: directory information and other student

records. Directory information is considered public information and will be released by the University upon

request, in accordance with existing law. Any student who does not wish directory information released

must submit the appropriate documentation indicating such with the Office of the Registrar.

In signing this waiver, I, __________________________________________________, give access of all

academic records at Texas A&M University-Corpus Christi to the individual(s) listed below. I hold the

authority to revoke this waiver at any time.

1. __________________________________________________

___________________

Name

Relationship

2. __________________________________________________

___________________

Name

Relationship

3. __________________________________________________

___________________

Name

Relationship

4. __________________________________________________

___________________

Name

Relationship

5. __________________________________________________

___________________

Name

Relationship

I understand that this request is permanent and will remain in effect until I request in writing that the

hold(s) be removed.

______________________________________

Student name

Student signature

______________________________________

Student ID

Date

For the Registrar’s Office Use Only

Processed by: ________________________________________

Date: ____________

Please return this form to the Registrar’s Office.

Revised 3/4/2009

Ferpa Waiver Form

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