FERPA Privacy Release Form

SOUTHWESTERN CHRISTIAN UNIVERSITY

The Family Educational Rights and Privacy Act (FERPA) is a federal law designed to protect the privacy of a student's education records. Since we are a university that receives federal funds, we are required to comply with FERPA. Once a student turns 18 years of age, some information from his/her record cannot be shared with others, including parents, unless the student gives written permission.
I,*

First NameLast Name
, hereby give Southwestern Christian University permission to share any information regarding my account with the Business office, Financial Aid, or Registrar's office at Southwestern Christian University with the following person(s):
Authorized person number 1's name (if you do not wish to authorize anyone, put "nobody")*
My relationship with person number 1 (parent, sibling, wife, boyfriend, etc)
Authorized person number 2's name
My relationship with person number 2
Authorized person number 3's name
My relationship with person number 3
Students Unique Password that can be used to verify that an individual is authorized to receive information about my academic record*
It is the student's responsibility to create and communicate this password.

I understand that Southwestern Christian University is not responsible for any situations that may result from information shared with the individuals listed above. This release is in effect until revoked in writing by the named student.
Student Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: