Consent to Release of Information
Family Education Rights and Privacy Act (FERPA)
I understand by signing this authorization, I am voluntarily waiving my rights of non-disclosure of my educational records listed above under the federal law only as to the person(s) or organization specifically listed. This release does not permit the disclosure of these records to any other person(s) or entities without my written consent. I understand that I am not required to release my education records to anyone and that this release remains in effect until I request in writing the revocation of this consent. I also acknowledge that I have received information regarding FERPA and I understand the information presented. If I have further questions, I will contact the counseling department for assistance.
6200 College Avenue, Snyder, TX 79549. 325-573-8511. 1-888-468-6982. 325-573-9321 fax. firstname.lastname@example.org