FERPA Form

FERPA Form

This form is to be completed by the student of Esperanza College of Eastern University
The purpose of this consent is to allow parental access to student information in compliance with (FERPA) the Family Education Rights and Privacy Acts of 1974, and the amendments to this act. Appointments are required prior to meeting with Esperanza College personnel, including but not limited to Academic Advisor, College Deans, Counseling and or Academic Support, Financial Aid Representative, and or
Registrar Coordinator. Even with this consent, confidential information will
not be provided over the phone unless the originates from an Esperanza College
office where the student is present. Information will be provided in person
with picture ID or by letter with the signature of the above parent/guardian.
For additional information concerning Esperanza College FERPA compliance,
contact Esperanza College of Eastern University Registrar Coordinator, at
215-324-0746 ext.415 or esperanzaregistrar@eastern.edu
Student Information
Name / Nombre:*

First NameLast Name
Email / Correo Electrónico:*
Email
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
All my information above is correct.*

I agree
Parent/Guardian to whom information may be released
Name / Nombre:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email / Correo Electrónico:
example@example.com
Phone Number
Please enter a valid phone number.
I give consent to parent/guardian, mentioned above according to the compliance with (FERPA) with the Family Education Rights and Privacy Acts of 1974, and the amendments to this act.

I agree
Other Parent/Guardian to whom information may be released
Name / Nombre:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email / Correo Electrónico:
example@example.com
Phone Number
Please enter a valid phone number.
I give consent to parent/guardian, mentioned above according to the compliance with (FERPA) with the Family Education Rights and Privacy Acts of 1974, and the amendments to this act.

I agree
Grant Permission
I understand that all the information above is accurate and I give consent to the parent/guardian mentioned above*

I understand but at the moment I do not want anyone to have access, and I am ready to submit this formI agree, and I am ready to submit this form
Esperanza College of Eastern University

4261 N. 5th Street

Philadelphia, PA 19140
Should be Empty:

FERPA Form

Student Information

Parent/Guardian to whom information may be released

Other Parent/Guardian to whom information may be released

Grant Permission