THE CITY UNIVERSITY OF NEW YORK 

 

FERPA RELEASE FORM 

 

PERMISSION FOR ACCESS TO EDUCATIONAL RECORDS 

 

This form allows students to grant third parties, including parents, access to their educational records maintained 
by the student’s college. The Family Educational Rights and Privacy Act of 1974 (Buckley Amendment) prohibits 
access to, or release of, educational records or personally identifiable information contained in such records (other 
than directory information) without the written consent of the student, with certain regulatory exceptions. A 
description of a student’s rights under FERPA is set forth in more detail in the college catalog. 

 

Student Name (Please Print): _____________________________________________________ 

 

Social Security Number or University Identification Number ___________________________ 

 

I, the undersigned, hereby authorize ________________ College of The City University of New York, to release 
the following educational records and information (identify records or types of records below): 

____________________________________________________________________________________________
____________________________________________________________________________________________ 

 

These records should be released to the following person/agency (identify name and address of person/agency to 
receive information): 

____________________________________________________________________________________________
____________________________________________________________________________________________ 

 

These records are being released for the purpose stated below: 

____________________________________________________________________________________________
____________________________________________________________________________________________ 

 

_______________________________ ___________________________________ 

Student’s signature Date 

 

Please note that “directory information” can be given out without the student’s written consent. The City 
University of New York defines directory information to include such information as a student’s name, attendance 
dates, home and e-mail address, telephone number, date and place of birth, photograph, status (e.g., full/part-time, 
undergraduate/graduate), degree program, credits completed, major, student activities and sports, previous school 
attended, and degrees, honors and awards received. This information may be released to anyone, unless restricted 
by written authorization of the student. Contact the Registrar’s Office at your campus if you wish to restrict this 
information. 

 OGC 1/06 

 

 

Return this completed form to: 

Office of the Register, Records & Transcripts 

Shuster Hall, Room 102