Family Educational Rights and Privacy Act (FERPA) Release of Information Form

Family Educational Rights and Privacy Act (FERPA)

First Name *

Last Name *

DOB (MM/DD/YY) *

The Family Educational Rights and Privacy Act (FERPA) affords certain rights to students concerning the privacy of, and access to, their education records. Students may choose to complete and submit this form to the Registrar allowing the release of their education records to specified third parties. Please note that while this form authorizes Salina Area Technical College to release education records to third parties, it does not obligate Salina Area Technical College to do so. Salina Area Technical College reserves the right to review and respond to requests for release of education records on a case-by-case basis. For additional information, visit Salina Area Technical College’s current catalog or https://studentprivacy.ed.gov/?src=fpco.

Option 1 - I am a current student and already have an active FERPA form on file. Therefore, I only need to complete my name and DOB above; and check the box below. (If the box below is checked, STOP HERE. Do not complete the rest of this form.)

I am a current student and already have an active FERPA form on file.

Option 2 - DO NOT RELEASE EVEN MY DIRECTORY INFORMATION TO ANYONE, INCLUDING THE MEDIA. I was informed of my FERPA rights. By checking this box, I am indicationg that I do not want Salina Tech to release my information to anyone other than myself. I understand that Salina Tech will not include my name or photo in any media publications including, but not limited to, honor roll or graduation lists, awards and recognitions, etc., nor will Salina Tech confirm or deny my enrollment to outside parties such as potential employers, tool vendors, ect. (If the box below is checked, SKIP OPTIONS 3 AND 4 and proceed to the signature section.)

DO NOT RELEASE EVEN MY DIRECTORY INFORMATION.

Option 3 - Only release my directory information. Do NOT release any FERPA- protected information to anyone other that myself. I was informed of my FERPA rights. By checking this box, I am indicating that I do not want any FERPA-protected information (such as my attendance, grades, financial aid, or billing records) released to anyone besides myself. (If the box below is checked, SKIP OPTION 4 and proceed to the signature section.)

Release ONLY my directory information,

Option 4 - Education Information to Release to Third Parties (Check all that apply)

Accounting- Includes tuition and fee balances, financial holds, mailing and billing address, payment plans, accounting statements, collections and debt information.

Registration- Includes current enrollment, class schedule, dates of enrollment activity, enrollment status, semesters attended and mailing address information.

Academic Records- includes courses taken, grades received, GPA, academic progress, honors, transfer credit awarded and degree(s) awarded.

Admissions- Includes dates of application, programs selected, documents received, documents pending, dates of admission, admission status, and conditions of admission.

Individual(s) to release information to. (You may add more than one. Enter all of the contact information for each below.)

Individual #1 Info:

Last Name

First Name

Phone Number

Relationship

Individual #2 Info:

Last Name

First Name

Phone Number

Relationship

Individual #3 Info:

Last Name

First Name

Phone Number

Relationship

For OPTIONS 2, 3, or 4, SIGN and DATE HERE This authorization is valid until I am no longer a student at Salina Tech and/or until I have had two consecutive semesters of not being enrolled at Salina Tech. Upon my return to Salina Tech, I will need to complete an updated FERPA form. I understand that I may cancel this FERPA information release at any time by submitting another FERPA form to Salina Area Technical College Student Services Office.

Student Signature and Date

clear

Salina Area Technical College does not discriminate on the basis of race, religion, color, sex (including pregnancy and gender identity), sexual orientation, parental status, national origin, age, disability, family medical history or genetic information, military service, or any other non-merit based factor in admission or access to, or treatment in its programs and activities. Any person having inquiries concerning compliance with the regulations implementing Title VI, Title VII, ADA, Title IX, Section 504, Title II, GINA is directed to contact the Vice President of Operations, 2562 Centennial Rd, Salina, KS 67401, 785-309-3100.

For more information about our completion, on-time graduation rates, cost, placement rates, and median debt incurred, please go to http://www.salinatech.edu/ and search by program of study.