Consent to Release Student Information
The Family Educational Rights and Privacy Act of 1974 (FERPA) and the University of Hartford protect the privacy of student educational records and generally limit access to the information contained in those records by third parties.  Please visit http://uhaweb.hartford.edu/sasc for responses to frequently asked questions regarding this Act.
You may choose to grant the University of Hartford permission to disclose educational records to certain individuals in accordance with FERPA and University policy.  Please complete this form and return it to the Student Administrative Services Center (SASC) CC220, 200 Bloomfield Avenue, West Hartford, CT 06117, or your College Dean's Office, Residential Life Office, or other student services offices as indicated below.  The form will be kept on file in the Registrar's office.
Note:  This form does not give permission to release any information with regard to health, counseling, disability, or public safety records.  PLEASE READ THE INFORMATION REGARDING FERPA ON THE BACK OF THIS FORM.
Student's Name:  _____________________________________				University ID #:  ____________________
I have indicated below the individual(s) or agency to whom the University may release information from my educational records:
The individual(s) named below may have access to the following information:  (Check all that apply)
First Individual/Agency				Second Individual/Agency
Full Name				Full Name
Relationship to Student				Relationship to Student
Street				Street
City / State / Zip Code				City / State / Zip Code
Telephone Number				Telephone Number
		Academic Information
		Billing/Payment Information
		Financial Aid Information
		Residential Life Information
		Student Conduct Information - *current
		Student Conduct Information - all
		Include all of the above
		Remove all access
* current refers to either the year in which you are currently enrolled, or if completed after the spring term it refers to the next academic year.
I understand that I can revoke this release at any time by notifying SASC in writing (please note, it takes 24 hours to process the request).  Your request will automatically expire upon graduation or withdrawal from the University of Hartford.  By signing this form I acknowledge that I have read the information on the back of this form.
Student's Signature				Date
				Please attach additional forms if you are giving permission
Print Name				to release information to more than two individuals/agencies.
About FERPA
The following information is an excerpt from the U.S. Department of Education website at http://www.ed.gov/policy/gen/reg/ferpa/index.html.
FERPA is a Federal law that protects the privacy of student education records.  The law applies to all schools that receive funds under an applicable program of the U. S. Department of Education.
FERPA gives parents certain rights with respect to their children's education records.  These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level.
Generally, schools must have written permission from the student in order to release any information from a student's education record.  However, FERPA allows schools to disclose those records, without consent, to the following parties or under the following conditions (34CFR~99.31):
	School officials with legitimate educational interest.
	Other schools to which a student is transferring.
	Specified officials for audit or evaluation purposes.
	Appropriate parties in connection with financial aid to a student.
	Organizations conducting certain studies for or on behalf of the school.
	Accrediting organizations.
	To comply with a judicial order or lawfully issued subpoena.
	Appropriate officials in cases of health and safety emergencies.
	State and local authorities, within a juvenile justice system, pursuant to specific State law.
Schools may disclose, without consent, "directory" information such as student's name, address, telephone number, date and place of birth, honors and awards, and dates of attendance.  However, schools must tell students about directory information and allow students a reasonable amount of time to request that the school not disclose directory information about them.  Schools must notify students annually of their rights under FERPA.  Any student objecting to the release of directory information should bring this to the attention of the registrar; accordingly, release of directory information for the particular student will be withheld.
Please be advised that although we have received said authorization for the release of information, the University reserves the right to deny the release of any and all information unless court ordered to do so.
The University of Hartford publishes FERPA information in the student handbook, The Source, every academic year.
Definitions
Academic Information includes registration, student schedule, grades, grade point average, class participation, assessment test scores, and academic progress status.
Billing/Payment Information includes access to all bills and student accounts receivable information.  This includes, but is not limited to, details of charges and payments, any financial restrictions, abatement forms, and student account status.
Financial Aid Information includes forms, documents, correspondence, etc. submitted to the financial aid office.  These include, but are not limited to, the Free Application for Federal Student Aid (FAFSA), tax returns, wage statements, verification worksheets, letters regarding financial aid eligibility, and information sent to the student.
Residential Life includes access to the student's file that includes, but is not limited to, the student housing application, incident communication reports, damage billing reports, and health and safety inspection forms.
Student Conduct Information includes misconduct violations resolved through the Student Misconduct Resolution Process.  According to the student's release, this may include just the current incident or current and past violations.