• Ferpa Consent Form

    Ferpa Consent Form

  • Date
     - -
  • Date of Birth
     - -

  • Parental or Guardianship Information

  • I hereby allow the disclosure of my or my child's educational information to the person or entity specified above (except health records):

  • I maintain my right to review prior disclosure to another my or my child's educational information for the following:

  • This Consent is effective for the following period unless otherwise revoked:

  • Date Effective From:
     - -
  • Date Effective Until:
     - -

  • By signing this form, I give my express consent for the release of the educational records and within or without the limitations specified above. 

    I declare that I am executing this consent voluntarily and not under any form of threat, duress or intimidation.

    Should I later decide to withdraw my consent, I may do so in the form of writing and be sent to the same institution executing this consent.

  • Clear
  • Date Signed
     - -
  • Should be Empty: