FERPA Student Consent to Disclose Education Records

FERPA - Student Consent to Disclose Education Records
In accordance with the Family Educational Rights and Privacy Act (FERPA) of 1974, the University at Albany must obtain written consent from a student before releasing the non-directory educational records of that student to a third party. Such written consent must be signed and dated by the student, specify the records to be released, state the purpose of the release, and identify the party or class of parties to whom the release may be made.

Students who ask to have directory information withheld will be unable to consent to release non-directory educational records.

Please read more about FERPA and directory information versus non-directory information here.
Student Status*

Current StudentFormer Student or Alumni
Former students and alumni must complete the Student Consent to Disclose Education Records form and sign in front of a notary public.

Notarized forms can be submitted to the Registrar's Office via email, mail, fax, or in person.
Student Name:*

First NameMiddle NameLast Name
Student ID Number:*
Please enter your student ID number not your social security number or NetID. Your ID number is a 9 digit number beginning with 00.
Student University at Albany Email Address*

Confirmation EmailAll notifications will be sent to your @albany.edu email address.
Note: If you want to provide consent to release different types of information to different individuals, please complete a separate form for each individual.
Full legal name(s) of person(s) or organization(s) to whom you are consenting the University may disclose information:*
Please state the purpose of the disclosure*
When providing the “purpose”, you will need to provide the reasons/purposes for which theUniversity is authorized to disclose information to the individuals named (for example, if you want information shared with them because they will be assisting you with financial aid applications and paying tuition, or providing academic support, you can list that as the purpose).
What information do you want to be released? (Select all that apply)*

Financial Aid RecordBilling RecordID Card Transaction/Account InformationOffice of Equity and Compliance RecordDisciplinary RecordAcademic StandingViolations of Academic Integrity RecordResidential Life FileProgram Completion StatusGrades (includes semester GPA and cumulative GPA)Class Enrollment (no professor or classroom information provided)Degree AuditStudent HoldsOther:
Please be advised that the University at Albany must authenticate the identity of a third party before releasing any information from the student's education record. As such, information is never released over the phone, by email, or by fax. In order to release information to a third party, the University at Albany will authenticate the third party's identity via photo ID either in person or via a Zoom call.

You can read more about the release of student information to third parties here.
Please note that once you submit this form, you must check your email and complete the required follow up action before this form will be processed by the Registrar's Office.

By signing this form, you acknowledge:
- You are giving your written consent to the University at Albany, State University of New York, to disclose, make accessible, and furnish the above-mentioned information
- Your written consent will remain in effect until you notify the Registrar's Office to revoke it
- Student information is never released over the phone, by email, or by fax. In order to release information to a third party, we will authenticate their identity via valid, non-expired photo ID either in person or via a Zoom call
- If the University at Albany is not able to authenticate the third party, any requests made by the third party to access non-directory educational records of a student will be denied
- The specific information referenced in this form is being released to a third party at your request with the understanding that they will not release it to any other parties. The University at Albany is hereby released from all legal responsibility or liability pertaining to the release of the above-mentioned information
Student Signature:*
Please type full legal name
Date*

MonthDayYear
Should be Empty:

FERPA - Student Consent to Disclose Education Records

Note: If you want to provide consent to release different types of information to different individuals, please complete a separate form for each individual.