Release of Information Authorization

The Family Rights and Privacy Act of 1974 (FERPA) affords certain rights to students to inspect and review

the student records, the right to seek to have records amended, and the right to have some control over the

disclosure of information from the records.

Post-secondary institutions may disclose directory information, which includes:

• Student’s name

• Address

• Telephone number

• Date of birth

• Program of study

• Dates of attendance

• Degrees and certificates awarded

• Participation in officially recognized activities

Post-secondary institutions may not disclose student information (other than directory information) unless a Release of Information Authorization is on file. Form must be completed and signed by the student.

Please indicate your ONE choice below to Authorize or Deny the release of any educational records and/or financial account information. This submission supersedes all previously submitted authorizations.

First Name

Last Name

Student ID#

Do you authorize Ranken Technical College to release any information about you or your enrollment?

DENY. I do not authorize the release of any educational records and/or financial account information to anyone other than me.

ONLY FINANCIAL ACCOUNT INFORMATION RELEASE APPROVED. I authorize the release of information to only the parties indicated. Please print name(s), note relationship (parent, spouse, employer, etc.) and indicate access level below. This submission supersedes all previously submitted authorizations.

EDUCATIONAL RECORDS AND FINANCIAL ACCOUNT INFORMATION RELEASE APPROVED. I authorize the release of information to only the parties indicated. Please list name(s), note relationship (parent, spouse, employer, etc.) and indicate access level below. This submission supersedes all previously submitted authorizations.

Financial and/or Educational Release Details

Based on my selection for the above question, I agree to the following:

I hereby authorize Ranken Technical College to discuss my educational records, financial aid, and/or business office account information with the below person/people.

Based on my selection for the above question, I agree to the following:

I hereby authorize Ranken Technical College to discuss my financial account information with the below person/people.

Person(s) Authorized to Receive Information

Relationship to Student

Electronic Signature (Full Name)

Please check the box below.

I acknowledge that my eSignature above has the same meaning as a handwritten signature.