FERPA Release Form for Parents

I hereby declare that I am the the parent/guardian of {studentName}, whose name is mentioned above. In my capacity, I hereby exerise on behalf of my child the release his/her academic records in the custody of the institution where he/she is enrolled. The following records are hereby allowed to be released for the purpose stated below:

I hereby allow the release of my child's educational information (except health records):

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

The educational information selected above are granted for release for the purpose of

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

Date Effective From:

Date

Date Effective Until:

Date

By signing this form, I give my express consent for the release of the educational records within the restrictions selected above.

I declare that I am executing this form with the consent of my child and fully aware of the implications.

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

Name of Signatory

Signature

Date Signed

Date

FERPA Release Form for Parents

Parental or Guardianship Information

Consent