FERPA Notice Form

Document each student's consent around how their academic records may be used under FERPA. Students confirm every authorization, sign digitally, and leave a dated record, all from whatever device they have at hand.

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FERPA notice

Do you grant permission for this school/college/university to discuss academic records during counseling?

Yes, I grant permission No, I decline I need more information

Do you grant permission for this school/college/university to discuss academic records during online or live counseling using a third party video conferencing program with secured encryption?

Yes, I grant permission No, I decline I need more information

Do you agree to provide accurate information like personal details, educational background, career goals, and other school related data to this school/college/university?

Yes, I agree No, I do not agree I need more information

Do you understand that the purpose of FERPA is to protect your data and records as a student in this school/college/university?

Yes, I understand I do not understand I need more information

Have you read the policy and the other terms and conditions of the school/college/university?

Yes, I have read them Not yet I need a copy

Student information

Student's Name

Nombre

Apellido

Student's ID

Phone Number

Date of Birth

Student's Signature (optional)

Sign here

Date Signed

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