Student Waiver Form Of Ferpa Rights For Financial Aid Only printable pdf download

Student Waiver Form Of Ferpa Rights For Financial Aid Only

REINHARDT UNIVERSITY

STUDENT WAIVER FORM OF FERPA RIGHTS FOR FINANCIAL AID ONLY

Student Name: ________________________________ RU ID: ________ SSN: ___________________

Family Educational Rights and Privacy Act (FERPA)

The Family Educational Rights and Privacy Act (1974) protects the privacy of student records. Under the

Act, students may inspect and review their educational records, may seek to amend those records, and

may limit disclosure of information form those records. However, in regards to anyone besides the

student, access to student’s records is strictly limited.

I, ____________________________________________, understand that Reinhardt University will

PRINT FULL NAME

preserve the confidentiality of my records, in keeping with the Family Educational Rights and Privacy

Act (FERPA).

In signing this form, I am giving written permission for the professional staff of Reinhardt University’s

Office of Financial Aid to discuss my financial record & information with the following:

1. _____________________________________________________________________________

FIRST NAME

LAST NAME

RELATIONSHIP

2. _____________________________________________________________________________

FIRST NAME

LAST NAME

RELATIONSHIP

3. _____________________________________________________________________________

FIRST NAME

LAST NAME

RELATIONSHIP

Prior to the Office of Financial Aid staff releasing information to the above named, they

must be able to provide your address, date of birth, and Reinhardt University student id number.

This form will remain in effect until rescinded by the student’s written request.

___________________________________________________________________

STUDENT SIGNATURE

DATE

**This form is only for the Office of Student Financial Aid. A separate form will need to be completed for your Academic

records in the Registrar’s Office.

Return to:

Reinhardt University

Office of Financial Aid

7300 Reinhardt Circle

Waleska, GA 30183

Phone 770-720-5667

Fax 770-720-9126

05/2011

Student Waiver Form Of Ferpa Rights For Financial Aid Only