2017-2018 Ferpa Release Form - Contra Costa Community College District
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12017-2018 FERPA Release Form
The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student educational records,
both financial and academic. For the student’s protection, FERPA generally limits, with certain exceptions such as law enforcement, the
release of student information without the student’s explicit written consent. In order to release information concerning your financial
aid, the student’s authorization is required.
The Financial Aid Office will not provide information regarding a student’s financial aid application, status of eligibility to any other
individual, other than the student, without the student’s express written authorization on the 2017-2018 FERPA Release Form. This
form must be signed by the student in the presence of a Financial Aid staff member.
STUDENT INFORMATION:
NAME:
SID#
Name of Authorized Person:
Relationship to student:
Date of birth:
One time release
2017-2018 Academic year only
Name of Authorized Person:
Relationship to student:
Date of birth:
One time release
2017-2018 Academic year only
(
Third Party Release Only
IE: educational institution, Housing, etc.):
Information to Release:
Phone or Fax #:
One time release
2017-2018 Academic year only
Person(s) listed above may be provided information regarding (check all that apply):
The status of my financial aid file
My financial aid awards
Other: ______________________
State purpose of disclosure:
I understand that any and all personally identifiable information concerning my financial aid, with certain exceptions such as law
STUDENT DISCLOSURE AND RELEASE OF INFORMATION
enforcement, is protected under FERPA. I further understand that I may grant access of my student financial aid information to
individuals of my choice. This release allows the individual(s) listed above to access my student financial aid information. I will
advise those identified above that the Financial Aid Office will not release information over the telephone because of the inability
to accurately identify the caller without a photo ID.
By signing this release, I authorize the Financial Aid Office to release my financial aid information to the person(s) listed above. I
year. I also understand that I may cancel this authorization at any time by submitting a written request.
acknowledge that this release form is only effective for the 2017-2018 academic year and must be renewed each academic
Student Signature:
Date:
Date:
Financial Aid Staff:
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