FERPA Notice Form

FERPA Notice Form
The Family Educational Rights and Privacy Act (FERPA) is a law that protects the data and records of the students and cannot be accessed by anyone without the student's consent. For more information about FERPA, kindly check this webpage: https://www.schoolname.edu/FERPA.
Do you grant permission for this school/college/university to discuss academic records during counseling?*

Yes, I agree
Do you grant permission for this school/college/university to discuss academic records during online or live counseling using a third party video conferencing program with secured encryption?*

Yes, I agree
Do you agree to provide accurate information like personal details, educational background, career goals, and other school related data to this school/college/university?*

Yes, I agree
Do you understand that the purpose of FERPA is to protect your data and records as a student in this school/college/university?*

Yes, I understand FERPA
Have you read the policy and the other terms and conditions of the school/college/university?*

Yes, I confirm
By signing or completing this form, you understand and agree to this policy and the terms and conditions of the school/college/university.
Student's Name*

First NameLast Name
Student's ID Number*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Student's Signature*

Clear
Date Signed*

MonthDayYear
Date
Should be Empty: