FERPA CONSENT TO RELEASE STUDENT INFORMATION

 

TO: __________________________________________________________________                      (Name of North Carolina State University representative)

 

            I hereby consent to public disclosure of the education records listed below (e.g. tests, graded submissions, transcripts, etc.):

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

            I desire for my education records listed above to be released to the following persons:

________________________________________________________________________________________________________________________________________________________________________________________________________________________           

            The purpose of this consent is to: ________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

            This consent will expire: ____________________________________________

 

           

                        Name (print)_____________________________

 

 

                        Signature________________________________

 

 

                        Student ID Number________________________

 

 

                        Date_____________________________________