FERPA Release Form

Instructions: Please print out this form, complete the necessary information, and fax it to the military installation where you are taking course(s) using the appropriate fax number below.

I, the undersigned student, hereby authorize University of Maryland University College to release the specified educational records and information in accordance with this FERPA Release:

Educational Records and Information:      

• Date of Birth
• Home address and telephone number
• Course enrollment information

To: ___________________________________________
      (enter appropriate military installation)

For the purpose of: Attending class on the above named military installation. I understand that this consent shall remain in effect until revoked by me in writing.

_________________________________________________
Student's Signature

_____________________
Date

__________________________________________
Student's Name (please print)

__________________________________________
Student's Identification Number

_________________________________________________
Signature of Parent or Guardian (if student is under age 18)