FERPA_Authorization_Form_FERPA02

Family Educational Rights and Privacy Act (FERPA) Authorization Form
Authorization to Release Education Records
The Family Educational Rights and Privacy Act of 1974 (FERPA), as amended, governs an institution's ability to release confidential information in a student's education records. According to the Act, confidential education records may be released only with the permission of the student. By signing this release form, the student gives The International School of Hospitality (TISOH) permission to release his/her confidential information to the person and/or company designated below. By signing this release form, I agree that TISOH assumes no liability for honoring my instructions to release education records."
Student Information
Name (Last, First, Middle):*
Name While Attending TISOH (if different):
Last 4 Digits of Social Security Number OR Date of Birth:*
Student Email Address:*
example@example.com
Mobile Number:*
Format: (000) 000-0000.
Records to Be Released
All Financial RecordsAcademic Records & TranscriptsCertificate/Diploma
Other (Please specify):
Note: Fees may be assessed depending on the documents requested (e.g., official transcript, certificate, or diploma).
Recipient Information
Name:*
Organization (if applicable):*
Street Address*

Include Suite number if required

Street Address Line 2

City

Zip Code
City, State, Zip Code*

Street Address Line 2

City

Zip Code
Phone/Fax:*
Format: (000) 000-0000.

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