FERPA Consent for Release Form

FERPA Consent for Release Form

FERPA (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all educational agencies and institutions that receive funds under any program administered by the Secretary of Education ("Department"

FERPA gives parents certain rights with respect to their children's education records at schools towhich FERPA applies. These rights transfer to the student when he or she reaches the age of 18 or attends a postsecondary institution at any age ("eligible student" Under FERPA, a parent or eligible student must provide a signed and dated written consent before a school discloses education records or personally identifiable information from education records. 34 CFR § 99.30. See 34 CFR § 99.3 for the definition of "personally identifiable information." Exceptions to the general consent requirement are set forth in § 99.31 of the FERPA regulations. The term "education records" is defined as those records that are: (1) directly related to a student; and (2) maintained by an educational agency or institution, or by a party acting for the agency or institution. See 34 CFR § 99.3 for the definition of "education records." Accordingly, immunization and other health records, as well as records on services provided to students under the Individuals with Disabilities Education Act (IDEA), that are directly related to a student and maintained by a school are "education records" under FERPA.

Name of Student*

Date of birth*

Date

Grade level*

Student's mailing address*

CONSENT TO RELEASE The Family Educational Rights and Privacy Act (FERPA) establishes certain rights for parents and adult students regarding the privacy of their student's educational records. While family members and other individuals serving in a parent's stead as caretaker may have an interest in the student's record, access to or release of the educational record is only by written (parental/adult student) consent. Parents/Adult Students may choose to complete and submit this FERPA Release Form to allow access or release of their student's educational record. A release form must be completed for each individual to whom a parent/adult student wishes to authorize access/release of his / her student's educational records. Forms are valid for one year from the date of the signature or until the school receives notice of revocation in writing.

Name of parent/legal guardian/adult student*

Consent to release the information, as indicated below, to the following Individual and/or Organization:

List Individual or Organizations name:*

Relationship of this Individual or Organization to the student*

Address*

Phone*

Format: (000) 000-0000.

Email*

example@example.com

Academic recordsDisciplinary recordsAll information concerning my student's: 504 PlanIndividual Education Program (IEP)All other information placed in my child's education record e.g., accident reports, emergency contact information, administrative notes, etcOther

ACKNOWLEDGEMENT AND SIGNATURE I acknowledge by my signature that I understand that,although I am not required to release my student's records, I am giving my consent to release the information. This release will remain in effect for one year from the date of this form unless

Parent's/Adult Student Signature*

Date*

Date

District*

Advisor*