FERPA - Student Consent for Release of Records

Student Consent for Release of Records

Student Form
Under Federal legislation*, namely the Family Educational Rights and Privacy Act (FERPA) of 1974, I understand that my educational records cannot be released without my written permission.

*please click link for addiional Federal information.
Student First Name:*
Student Preferred Name:
Student Last Name:*
Student ID or Last 4 Digits of SSN*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Current Status the AAC*
To allow authorized parties to have access to your educational records without further consent being required, please complete this form. This form can be changed at anytime by the student.*

I do NOT consent to release my records to anyoneI hereby grant the Art Academy of Cincinnati the right to disclose my student records to the individuals listed below (i.e. parents, guardians, etc.)
Person #1

First NameLast Name
Relationship
Preferred Parent/Guardian

YesNo
Records to disclose:

Educational RecordsFinancial RecordsBoth Educational & Financial Records
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Person #2

First NameLast Name
Relationship
Preferred Parent/Guardian

YesNo
Records to disclose:

Educational RecordsFinancial RecordsBoth Educational & Financial Records
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Records may include: Financial aid records, billing information, grades, attendance and access to your Campus Café account.

For additional information on the Family Educational Rights and Privacy Act (FERPA) of 1974, please see the BFA Student Rights and Responsibilities section of the student handbook or the Registrar's web page.

All information specified above is limited to the following date range (note the end date listed is the expiration date when specified individuals have access to protected information). If the end date is left blank, then the last date of attendance will be used.
Start Date:*

MonthDayYear
Date
End Date:

MonthDayYear
Date
Signature*

Clear
Today's Date:*

MonthDayYear
Date
Should be Empty: