FERPA (Family Educational Rights and Privacy Act):
Your Right to Privacy Regarding your Academic Records and Progress

FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT RELEASE FORM

Under the provisions of the Federal Educational Rights and Privacy Act of 1974 (FERPA), you have the right to privacy with regard to your educational record here at Assumption College. Information regarding your academic status, grades, progress to degree, and overall campus experience cannot be revealed by us to anyone without your written consent. We at Assumption College encourage you to talk with your parents and/or guardians about their access to your educational information. Filling out this form and providing your digital signature will permit appropriate college personnel to discuss your academic record, status, and progress with the person or persons you name. If you do not complete this form, we will release no information regarding your academic record to anyone.

This agreement can be nullified or changed at any time by resubmitting the form in hardcopy, available in the Dean of Undergraduate Studies Office in 202 La Maison.

Question Title

Please enter the following information (your Student ID is the 7-digit number in your password).

Last Name:

First Name:

Student ID:

Question Title

I hereby give my permission for appropriate Assumption College personnel to discuss my educational records and progress with the following:

Name of Parent/Guardian

ELECTRONIC SIGNATURE

I understand that entering my first and last name constitutes a legal signature, and that an electronic signature has the same legal effect as a written signature.

Question Title

Please type your first and last name.

First and Last Name:

Date: