Authorization to Release Non-Directory Information (FERPA release)

FOR CURRENTLY ENROLLED STUDENTS, PLEASE COMPLETE EACH FIELD/SECTION BELOW

The Family Educational Rights and Privacy Act (FERPA) affords eligible students certain rights with respect to their education records. (An "eligible student" under FERPA is a student who is 18 years of age or older or who attends a postsecondary institution at any age.). This forms authorizes MSSU to release non-directory information to specific individuals or entities, though it does not obligate the institution to do so. This form does not cover request for records from the Student Health Center, Counseling Services, Disciplinary records, Disability Services. Students should contact these offices for such records.


Student Name:
 
Student MSSU ID No:
 
Email Address:
 
Phone no:
 
I hereby authorize MSSU to release specific or all educational records to the recipient(s).
Recipient's Full Name/Organization:
 
Recipient's Address:
 
Education records to be released (Check all that apply):
Education Records to be released (Check all that apply)
Duration of release (Select One)
Purpose
The following information constitutes your electronic signature:

The username and password are the same as used to log into Lionet.

Student Username:
(For example, doej001)

Password:
(Pin assigned with your S#)
Username
Password