The Family Educational Rights and Privacy Act of 1974 (FERPA) was designed to protect
the privacy of a student’s education records and to afford students certain rights pertaining to their
education records. The University of Dayton complies with FERPA and explains its procedures in
the University of Dayton Policy on Disclosure of Education Records. In accordance with
FERPA and its policy, the University of Dayton will disclose information from education records
with the student’s written consent.
By signing this document below, I consent for the appropriate record custodian to release
information from my education records to the following parties, as designated below:*
Parent(s)
Name(s)
Professor(s) or
All Professors Name(s)
UD Administrator(s)
Name(s) / Titles
Transferring Institution(s)
Name(s) of Institution(s) / Individuals’ Names
Other
Name(s) / Indicate Relationship (e.g., spouse, sibling, friend)
Types of Information
Grades/GPA Schedule Class Attendance
Billing statements, past due amounts, collection activity
Financial Aid awards, disbursements, eligibility
Disciplinary records
Records maintained by the Office of the Registrar
Student employment records
Records maintained by Center for International Programs
Other (explain):
For records maintained by the Office of Learning Resources, go to OLR and fill out their
Authorization to Release Information form.
This authorization lasts unless and until revoked by me, which I can do at any time by written
notification to the Registrar’s Office.
Student Signature Date
Printed Name Student ID Number
* Consistent with FERPA, the University generally does disclose certain records without a student’s consent in a number of specified
circumstances. For more information, please consult Section A(III)(a) of the
University’s Policy on Disclosure of Education
Records
. Using this form to release records that are not technically education records does not transform those records into
education records.
Note:
The form itself can be completed and submitted by logging into your student account through Porches OR
should be delivered by the student to Flyer Student Services located in Room 108 in St. Mary’s Hall; sent as a .pdf
from the student’s UD email address to fss@udayton.edu; or sent by a Custodian/Gatekeeper through campus mail
to Campus +1601.
Do not send form by facsimile.
112018_FERPA_Consent_Form
FERPA Form: Consent to
Disclose Education Records
