Release Of Financial Aid Or Veteran Information Authorization Form
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1OFFICE OF FINANCIAL AID/VETERAN SERVICES/SCHOLARSHIPS
Release of Financial Aid or Veteran Information Authorization Form
The disclosure of student information is governed by the policies of the Pensacola State College Board of Trustees and the Florida Department of
Education with the parameters established by state and federal laws, including the Family Educational Rights and Privacy Act (FERPA) of 1974.
FERPA restricts the type and amount of student record information that may be released without the student’s permission. (For detailed information,
refer to the Pensacola State College catalog.)
The written consent of the student is required for the disclosure of any information that is part of the student’s financial aid or veteran’s record. The
student must complete and sign this form. This form allows the release of financial aid or veteran’s information and is only valid for the academic
year in which this release is being requested and processed. Pensacola State College Financial Aid/Veteran Services office will mail the requested
information to the named individual or agency within 5-7 working days of receipt during non-registration periods. Pensacola State College Financial
Aid/Veteran Services office will not fax the completed document.
__________________________________________________________________________________________________________
The District Board of Trustees at Pensacola State College, Pensacola, Florida, is authorized to release any and all information requested pertaining to
the financial aid record or the veteran’s record of the following student:
Student Information
(please print)
Academic Year: ________________________
____________________________
____________________________________________________________________
Social Security Number (*see note below)
Student Last Name
First
Middle
____________________________
(______) _________________
(_____) _________________
Date of Birth (MM/DD/YYYY)
Home Phone Number
Work Phone Number
Release To:
(please print)
Name of Individual:
___________________________________________________________
Relationship to student: _____________________________________________________________
(i.e. caseworker, parent, legal guardian)
Name of Agency/Organization:
____________________________________________________
Street Address
___________________________________________________________________
City _____________________________ State _______________________ Zip _______________
Information/documents to be released:
______________________________________________________________
______________________________________________________________
Reason for release to anyone other than student: ___________________________________________________________
___________________________________________________________________________________________________
I certify that I am the above-named Pensacola State College student and as mandated by the Family Educational Rights & Privacy Act
of 1974 (FERPA), I am requesting the release of my financial aid information.
________________________________________________________________
_________________________________
Student Signature
Date
Type of I.D. Produced _____________________________Exp. _____________
Fin. Aid/Vet.Staff ____________________
I.D. # ___________________________________________________________
(full name)
NOTARIZATION REQUIRED (ONLY when student does not complete the form in the Pensacola State College Financial
aid/Veteran Services office).
_______
_________________________________________
_________________
__________________________
Signature, Notary Public
Type of I.D. produced
(ex. Drivers license, number, expiration)
State of __________________________________
County of __________________________________________
_________________________________________
____________________________________________________
Printed Name of Notary Public
Typed, or Stamped Commissioned Name of Notary Public
#2
*
Rev. 7/2015
Required and authorized by Title IV
of the Higher Education Act of 1965, as amended (§§483 and 484); 20 USC 1078, 1090, 1091 &
1092;
34 CFR 668.16; 34 CFR 668.33; 34 CFR 668.36; 34 CFR 668.32(i) and 34 CFR 668.36
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