Authorization to Release Limited Information
Authorization to Release Limited Information
The Family Educational Rights and Privacy Act( FERPA) of 1974 is designated to protect the privacy of educational records, to establish the rights of students to inspect and review the educational records, and to provide guidelines for the correction of inaccurate or misleading data through informal and formal hearings.
Lawrence Technological University’ s procedures for complying with the provisions of this Act can be found in the Student Handbook as well as the Undergraduate and Graduate Course Catalogs. In accordance with FERPA, the University may not discuss a student’ s academic and / or financial information to their parents, spouses, or guardian of the student.
By completing and signing this form, the student is authorizing Lawrence Technological University to release limited information to the designated organization. The information that can be disclosed to the designated organization is the term registered, class standing, number of semester hours enrolled, total number of semester hours completed, term grade point average, cumulative grade point average, and level( undergraduate or graduate). This authorization will remain in effect until the student submits written notice terminating this consent to the Office of the Registrar in Enrollment Services.
Submit the completed form to the One Stop Center located in the Taubman Building. STUDENT INFORMATION
STUDENT NAME ID NUMBER
STUDENT AUTHORIZATION I have read this document and fully understand the contents. I agree to the release of the limited information outlined above from the University to( Student Organization / Sorority / Fraternity must be indicated below).
( List Organization to whom information can be released)
( List Organization to whom information can be released)
Term this is effective: �Fall �Spring �Summer Year: 20 ____
Student Signature Date
OFFICE USE ONLY: Date Received: Date Entered in Banner:
Created 02 / 12
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