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FERPA Letter

AUTHORIZATION TO RELEASE INFORMATION OR REQUEST INFORMATION FOR LETTERS OF RECOMMENDATION

To: ________________________________________________________
(Name of University Official and Department)

Please provide information from the educational records of ____________________ [student's name] to:

____________________ [name(s), and if appropriate the relationship to the student such as "prospective employer" or "attorney"]

(Note: this Consent does not cover medical records held solely by Student Health Services or the Counseling Center - contact those offices for consent forms.)

The only type of information that is to be released under this consent is:

_____ transcript

_____ disciplinary records

_____ all records

_____ other (specify) ________________________________

The information is to be released for the following purpose:

____ employment

____ admission to an educational institution

____ other (specify) ________________________________

I understand the information may be released orally or in the form of copies of written records, as preferred by the requester.  I have a right to inspect any written records released pursuant to this Consent (except for parents' financial records and certain letters of recommendation for which the student waived inspection rights).  I understand I may revoke this Consent prospectively.

Name (print)_____________________________

Signature________________________________

Student ID Number________________________

Date_____________________________________