Military

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)

Location	Fax Number	Location	Fax Number
Aberdeen PG	410-273-0394	Henderson Hall	703-614-7848
Andrews AFB	301-420-3982	Patuxent River	301-862-2863
Bolling AFB	202-563-2364	Pentagon - Army	703-695-9613
Fort Belvoir	703-619-7063	Pentagon - AF	703-695-0214
Fort Meade	301-621-9898	Quantico	703-630-9333
Fort Myer	703-696-0145	Walter Reed	202-782-0664