Release of Student Information (Returning Student)

The Family Education Rights and Privacy Act (FERPA), affords certain rights to students concerning the access to, and privacy of, their educational records to specified third parties. This form authorizes BAC to release your education records to parties you select.

First Name

Last Name

Birthdate *

Consent to Release Information: *

I want to release my records to the third parties specified below

I don't want to release my records to any third parties

DeletePerson _ID_
Name of Person who may receive information upon request:
First Name Last Name Relationship Please describe: E-mail Address to which information may be sent. Phone Number Education records to be released upon request (check all that apply) * Education records to be released upon request (check all that apply) * Student Account information (statements, charges, credits, payments, past due amounts, holds, etc.) Financial Aid information (awards, applications, loan information, disbursements, eligibility, etc.) Academic information (transcripts, grades/GPA, schedule, enrollment status, etc.) Office of Disability Resources information All of the above

Add Person

Information Regarding Access

The access to your records granted to other parties by this form can be indefinite or limited. When would you like that access to expire? *

Until I communicate to revoke.

When I graduate or when all balances have been paid (whichever is later)

On:

Enter Expiration Date *

If you leave BAC without graduating, access to records will be set to expire six months after the date of withdrawal (unless you contact the registrar’s office to specify another expiration date).

If you have any additional instructions or comments on what records we can release to the third parties indicated above, please let us know here.

If you would like to request a directory block, please contact registrar@brynathyn.edu.

You may revoke or extend the rights of access at any time by contacting the registrar’s office.

Signature

Today's Date *

Admissions

Release of Student Information (Returning Student)