FERPA Records Access Request Form
Request access to education records in accordance with FERPA. Please complete all sections accurately.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Relationship to Student
*
Please Select
Self
Parent or Guardian
School Official
Other
Student Full Name
*
First Name
Last Name
Student Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Records Requested (Please specify the records you wish to access)
*
Purpose of Request
*
Please Select
Review for accuracy
Transfer to another institution
Personal review
Other
Preferred Delivery Method
*
Electronic Copy (Email)
Physical Copy (Mail)
In-Person Pickup
Additional Comments or Instructions
Signature (Type your full name as your digital signature)
*
Submit Request
Submit Request
Should be Empty: