Fillable Ferpa Waiver Request Form printable pdf download

Ferpa Waiver Request Form

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Office of the Registrar

4204 E. Fowler Ave, SVC1034 Tampa, Fl 33620

FAX (813) 974-5271

privacy@usf.edu

FERPA WAIVER REQUEST

FORM

The Family Educational Rights and Privacy Act (FERPA) of 1974, is a federal law that establishes

the rights of students with regard to education records, and ensures students of the right to privacy

and confidentiality with respect to those records. This form is provided as a means for students to

give the University of South Florida permission to discuss and/or disclose their academic records

with someone other than themselves (i.e., with a parent, guardian, etc.).

Student’s Authorization to Release Information

In signing this waiver, I, ___________________________________________,

U#____________________, give access of all my academic records at the University of South

Florida to the individual(s) listed below. (Individual must know student’s USF ID Number, date

of birth, and FERPA password before information can be released.)

______________________________________________ _____________________________

Name

Relationship to student

______________________________________________ _____________________________

Name

Relationship to student

I understand this release authorization remains in effect as long as I am a student at the University of

South Florida or until I revoke this authorization in writing.

I have carefully read the forgoing authorization and fully understand the meaning of this waiver

form. I affirm that I have signed this authorization voluntarily.

_____________________________________________________________________________

Student’s Name (please Type or print)

________________________________________________________ ____________________

Signature

Date

RETURN COMPLETED FORM TO: Registrar’s Office in the Student Services Building SVC1034

OFFICE USE ONLY

Processed by

__________________________________________ Notification Sent ____________________________________

FERPA Password_________________________________________________ Date ___________________________________

Student USF e-mail_____________________________________________

JD Revised 07/09/2010

Ferpa Waiver Request Form

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