Ferpa Form Authorization For Release Of Student Information printable pdf download

Office of Undergraduate Admissions

11000 University Parkway

Bldg. 18

Pensacola, FL 32514

E: admissions@uwf.edu

P: (850) 474-2230

F: (850) 474-3360

FERPA Form

Authorization for Release of Student Information

in accordance with Family Educational Rights and Privacy Act (FERPA)

The purpose of this release is to facilitate the communication of student information to authorized individuals identified by

the student. Generally, this information will be released without student notification; however, the University reserves the

right to notify students prior to the release of information.

The Family Educational Rights and Privacy Act of 1974, as amended, protects the privacy of education records, establishes the

rights of students to inspect and review their education records, and provides guidelines for the correction of inaccurate or

misleading data through informal and formal hearings.

I. Student Information:

970 -

- ______

UWF ID:

Name of Student: ____________________________________________________________________

(please print)

Address: ___________________________________________________________________________

Box # or Street

City

State

Zip

Phone #

II. Recipient Information:

I authorize the University of West Florida to release my educational records to the person(s) specified below.

Name(s): ___________________________________________________________________________

(please print)

Address: ___________________________________________________________________________

Box # or Street

City

State

Zip

Phone #

Name(s): ___________________________________________________________________________

(please print)

Address: ___________________________________________________________________________

Box # or Street

City

State

Zip

Phone #

My educational records may be released upon written request by the listed person(s) bearing a signature, via mail

or fax, to the Office of the Registrar. Information will be released on an individual basis when contacted by the

authorized person(s). Records which may be released include, but are not limited to: Financial Aid, Disciplinary,

Grades, and Student Account.

III. Consent:

The above information may be released with my full consent. I understand that this authorization remains in

effect until my written revocation is received by the Office of the Registrar.

__________________________________________________ _______________________________

(Student Signature)

(Date)

Ferpa Form Authorization For Release Of Student Information

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