Ferpa Waiver Form

Ferpa Waiver Form
The Family Educational Rights and Privacy Act (FERPA) of 1974 is Federal law designed to protect the privacy of students as to their educational records in the school where they are enrolled. The law permits the students to know the records that the school may disclose to another or lets the students control the disclosure of their personal information. School officials can only, therefore, share your education records to third parties if you provided prior written consent, except under limited exceptions provided for by FERPA. You can also obtain more information through the U.S. Department of Education’s website: www.ed.gov/policy/gen/guid/fpco/ferpa/.
Date
MonthDayYear
Date
Student Name
First NameMiddle NameLast Name
Student Identification Number
Date of Birth
MonthDayYear
1
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Days
Age Calculation
Parental Information
Name of Mother or Guardian
Address of Mother or Guardian
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
I hereby waive my right to review prior disclosure to another my or my child's educational information:
Purpose
This waiver is effective for the duration of:
By signing this form, I waive my right to withhold and consent to the release of the education records specified above. I likewise affirm that I have made this consent and waiver voluntarily. In any case that I decide to withdraw or revoke my waiver, I may do so by submitting a written request signed by me to the institution.
Name of Signatory
Signature
Clear
Date Signed
MonthDayYear
Date
Should be Empty:

Ferpa Waiver Form

Parental Information