Ferpa Waiver Authentication Form (Page 2 of 2) in pdf

Ferpa Waiver Authentication Form Page 2

FERPA WAIVER - AUTHENTICATION FORM

I understand that, in order for Greenfield Community College to disclose personally identifiable information from my

educational records to anyone other than myself, I must provide consent. I further understand that, for any such

disclosure over the phone, even to myself, the college must authenticate the caller.

The following FERPA password must be provided, either by myself or by any named individual below, when making a

telephone inquiry.

Student’s Authorization for Exchange of Information:

I hereby authorize exchange of information between the Financial Aid Office of Greenfield Community

College and the parties listed below for the purpose of determining the amount of financial aid for which I

may be eligible, as well as any awards I may receive. I also authorize the exchange of information

regarding my student billing account and any payment arrangements between the Bursar’s Office at GCC

and parties listed below.

The party or class of parties to whom a disclosure may be made is: Name(s):

____________________________________________________________________________________

Relationship: □ parent □ guardian □ spouse □ sibling □ other _________________

FERPA Password ___________________________

(The FERPA password cannot be your date of birth, any part of your student ID # or SSN, or your My GCC

password).

The person to whom disclosure is made must also provide my Student ID Number if he/she makes a telephone inquiry.

_____________________

______________________

______________

________

Student Name (Please Print)

Student Signature

GCC Student ID

Date

Financial Aid Ofﬁce, Greenﬁeld Community College

One College Drive, Greenﬁeld, MA 01301

Phone: (413) 775-1109 • Fax: (413) 775-1133

Email: ﬁnancialaid@gcc .mass.edu

Ferpa Waiver Authentication Form Page 2