Form: FERPA Request to RELEASE ENG

FERPA

Family Education Rights and Privacy Act Request to RELEASE Form
Family Education Rights and Privacy Act (FERPA)

FERPA is a Federal law that protects the privacy of student education records, both financial and academic. For the student’s protection, FERPA limits the release of certain student record information without the student’s explicit consent. However, the law also considers some student information to be Directory Information and is considered public. A student is covered by FERPA at the time of his/her enrollment in courses at the seminary.

Directory Information includes: name, address, e-mail address, phone number, dates of enrollment, enrollment status, major, program, academic awards and honors, and degrees received. This means Grace School of Theology can release this information to anyone who requests it. You have the opportunity to suppress parts or all of this information from public release.
FERPA RELEASE

A student may waive this protection and give access to his/her records to individuals of his/her choice. This release allows the individual(s) named to access educational or financial records as defined. For this to happen, students must complete and submit this form.
Full Name*

First NameLast Name
E-mail*
Phone Number

Area CodePhone Number
Birthdate*

MonthDayYear
Student ID #*
Release all Academic/Transcript Records (records include: transcripts, admission and registration information, schedule information, assessment test scores, Academic Standing, residency information, and any other documentation contained in the academic records)

Yes, Release
Release all Student Account Records (records include: amounts due for tuition and fees, sources of payment for tuition and fees, refund information, records hold information as it relates to parking tickets, library fines, financial aid repayments and any other accounts receivable information contained in student account records)

Yes, Release
Release all Instructor/Classroom Records (records include: attendance records, progress reports, test and homework scores, if available. Please note: instructors are not required to provide progress reports, and retain only those records which make up the final grade. FERPA pertains to the release of records. Instructors are not required to have conversations about academic progress with anyone other than the student)

Yes, Release
Release all Financial Aid Records (records include: status of file, award and disbursement of funds information, Academic Standing, income information, and any other information contained in the application or financial aid file).

Yes, Release
Other (Please Specify)
Who will receive these records?

The following individual/organizations are authorized to receive/access the letter/information indicated above.
Spouse (Full Name)
Church
Agency
Mother/StepMother (Full Name)
Father/StepFather (Full Name)
Other
Their Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Their E-mail
Their Phone Number

Area CodePhone Number
Although I understand I am not required to release this information, I am giving my consent to Grace School of Theology to disclose these records. I also understand that this release remains in effect for the remainder of my time at Grace School of Theology, unless I revoke my consent with another Release Form. I understand that this information may be released orally, in writing, in electronic formats, or in the form of copies of records as preferred by the requestor.
I would like to revoke a previous Request to Release.

Yes, Revoke
Please tell us the name of the person or organization that no longer has access to your records. (This does not include Directory Information.)
Should be Empty:

FERPA

FERPA RELEASE

Who will receive these records?