Authorization to Release Records Authorization to Release Records The Family Educational Rights and Privacy Act (FERPA) prohibits an educational institution from releasing confidential, non-directory information about a student without his/her consent. Students can waive this right for a third party, including a parent, guardian, or spouse, to have access to this information by completing written authorization, such as this form. PLEASE NOTE: Students are not required to complete or submit this form. EWC provides this form for the convenience of our students only. Releasing any information is THE STUDENT’S decision based on his/her needs. STUDENT INFORMATION Full Legal Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code EWC Student ID Number* Social Security Number (Last 4 digits) Phone Number (Include area code)* Email AUTHORIZATION I hereby authorize Eastern Wyoming College and/or its employees to release confidential information such as grades, academic progress reports, financial aid, disciplinary actions, and financial account information to the person(s)/ agency(ies) listed herein. This authorization shall be considered as a waiver of any and all my rights and/or privileges as provided under the FERPA, as amended. I understand that my confidential information will only be released upon receipt of a request for specific information and that I may cancel this Authorization at any time. I authorize the following to be released (check all that apply):* Business Office (Includes student account information such as billing information, amounts due, sources of payment, refund information and any other accounts receivable information) Financial Aid Office (Includes file status, award and disbursement information, Satisfactory Academic Progress status, income information, and any other information in the financial aid file) Admissions/Records (Includes application status, assessment scores, transcripts, registration/ info, grades, attendance, Academic Progress status, residency information, and any other documentation in academic record) Student Affairs (Includes disciplinary records, academic dishonesty, conduct or behavior records) All of the Above Other If Other Please Describe:* Counseling and/or disability records are considered medical records and are not covered under FERPA rules. A separate release form must be obtained to release information from those records. Persons to whom my information may be released: Name* First Last Relationship* Do you need to add another person?* Yes No Name* First Last Relationship* CERTIFICATION AND SIGNATURE Signature* By signing this form, I authorize EWC to release and disclose information from my education records as specified. This authorization remains in effect until I revoke it in writing or by completing the reverse side of this form. Date* Name This field is for validation purposes and should be left unchanged.