Release of Student Information Form – White Mountains Community College

The Family Education Rights & Privacy Act (FERPA) is a federal law which influences record keeping in most colleges and universities. It is popularly known as the “Buckley Amendment”. The law requires that the educational records of students in colleges and universities receiving Department of Education funds remain confidential. The Buckley Amendment allows others to access a student’s educational records only if the student consents.
I,*
Name of Student
Student ID
Email*
authorize the appropriate staff of White Mountains Community College to discuss the following information with the following person(s).
Check All Areas That Apply*
- Grades
- General Academic Progress
- Finances/Billing Information
- Financial Aid Information
May be discussed with the following:*
Name Relationship
Electronic Signature*
"By typing your name, you consent and agree that your electronic signature is the legal equivalent of your manual or handwritten signature. You agree to be legally bound by this agreement and any terms, disclosures, or records delivered to you electronically under the federal ESIGN Act."
I understand that this release of information does NOT allow access to the Student Information System (Student Records via the Internet) or Official Transcripts.

This authorization shall continue indefinitely or until the student named above notifies the Registrar’s Office otherwise in writing.

897

Students enrolled fall 2019

Name	Relationship