FERPA/Buckley Amendment *Release Form

The Family Educational Rights and Privacy Act (FERPA) is a Federal law designed to protect the privacy of a studentís education records. The law applies to all schools which receive funds under an applicable program of the U.S. Department of Education.

This act protects your personal information from being distributed to third parties. The Financial Aid Office must have a signed acknowledgement from you before information can be released to a second party (i.e., spouse, parent, etc). Please complete the following form only if you want another party to have access to this information.

Studentís Social Security Number:

____________________________

I ______________________________________________ give permission to Barstow College Financial Aid Office to release information regarding my financial aid file to:

(Please be specific)

______________________________________

Name/DOB

________________________________________________________________________

Address (Street, City, State, Zip)

___________________________

Phone Number

___________________________ ____________________________

Studentís Signature Date

For further information of FERPA/Buckley Amendment, please go to: www.ed.gov/policy/gen/guid/fpco/index.html

A government issued ID is required upon receipt of this document.