FERPA: Release Form Home » FERPA: Release Form Authorization to Release Information In accordance with the Family Educational Rights and Privacy Act of 1974 (FERPA), the undersigned student hereby permits Voorhees University to disclose the information specified below to the following individual(s) or agency(ies): The student authorizing the release of his/her educational records must sign & present this form to the appropriate office with a photo ID to verify authenticity of this release. Student InformationName(Required) First Middle Last Student ID(Required)Date of Birth(Required) MM slash DD slash YYYY Email(Required) Cell Phone Number(Required)Classification(Required)I Grant The Names Listed Below Access To My Academic RecordsList of NamesNameRelationship To Student Add RemoveClick the (+) to the left to add additional names.Place a check next to records that you wish to make available:(Required) All Academic/Transcript Records (records include: transcripts, admission and registration information, schedule documentation contained in the academic records, degrees, academic awards, academic probation, SAP). Instructor/Classroom Records (records include: attendance, progress reports, test and homework scores if available. Please note: instructors are not required to take attendance or provide progress reports, and retain only those records which make up the file grade. FERPA pertains to the release of records. Instructors are not required to have conversations about progress with anyone other than the student). Student Affairs (records include) Judicial (pertaining to the above student), Housing (incidents reports, fines,) Security (parking violation, fines, incident reports), Athletics (dismissals, grades, sports eligibility) Participation in official recognized clubs, organizations, and activities. All College Records Other OtherPlease Note: Records for Counseling and services for Students with Disabilities are considered medical records and are not covered under FERPA rules. A separate release form must be obtained from these departments.Consent I understand the information may be released verbally or in the form of copies of written records, as preferred by the requester. This authorization will remain in effect from the date it is executed until revoked by me, in writing, and delivered to the Department(s) identified above.Consent I release Voorhees University, its employees and the person(s) providing the above described reference or evaluation from all claims and liability for damages that may result from their compliance with this request.Signature
