McKendree University eForms - FERPA Release Form

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FERPA Release Form

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Use this form to give permission for others to access your financial and/or academic records.

If you do not click "Continue" or "Save and submit later" within 2 hours (10:11 AM), your data will be lost. (fields marked with a * are required)

Submitter Information

First Name *	Middle Name	Last Name *	Suffix


Phone *	E-mail *

Student ID Number*


Permission to Release Financial Information


I wish to give permission to release financial information:


	*


I give permission for McKendree University personnel to speak with and/or disclose information regarding my student financial records to persons, companies or organizations listed below. I understand this release form will remain in effect unless I provide the Business Office or Office of Financial Aid with written notice revoking the release of financial information.

Name:

Relationship to Student:

email address:

Name:

Relationship to Student:

email address:

Name:

Relationship to Student:

email address:

Name:

Relationship to Student:

email address:


Permission to Release Academic Information


I wish to give permission to release academic information:


	*


I give McKendree University personnel permission to discuss my academic information with the individual(s) listed below. I understand this release form will remain in effect unless I provide the Academic Records Office with written notice revoking the release of academic information.


I wish my academic information released to the same individual(s) listed above:


	*


Please list any additional individuals below:

Name:

Relationship to Student:

email address:

Name:

Relationship to Student:

email address:

Name:

Relationship to Student:

email address:

Name:

Relationship to Student:

email address:


In order to release academic information, we require a password be given to both the University and the individuals listed. So that we know we are speaking to only those who have permission, we will ask them to give us the password before we will talk with them.

Password:


	*


IT IS THE STUDENT'S RESPONSIBILITY TO NOTIFY EVERYONE ON THE LIST OF THE CORRECT PASSWORD.


Please use the space below to enter any additional information or comments. If you are required to send a revision, you may use this box for your additional information.

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