FERPA Release Form - Spoon River College

Subject to certain exceptions set forth in the Federal Family Education Rights and Privacy Act (FERPA) of 1974, Spoon River College (SRC) will not provide personally identifiable student information (including but not limited to grades, billing, tuition and fees, assessments, financial aid and other student records) to third parties absent the student’s consent. Third parties include parents, spouses and third-party designees.

To grant permission to a specific designee, complete and submit the form below, then print the completed form using the print button at the bottom, sign it, and return the finished form to:
Admissions Office
Spoon River College
23235 North Co. 22
Canton, IL 61520

FERPA Release Form

Name

First Name

Last Name

SRC Student ID Number

Information Released to:

Name:

Relationship to Student:

Check all that apply: (Please note: Only SRC generated information may be released.)

All Academic/Transcript Records (Records include: transcripts, admission and registration information, schedule information, assessment test scores, Satisfactory Academic Progress status, residency information, and any other documentation contained in the academic record.)

All Student Account Records (Records include: amounts due for tuition and fees, sources of payment for tuition and fees, refund information, records hold information as it relates to library fines, financial aid repayments, and any other accounts receivable information contained in student account records.)

Instructor/Classroom Records (Records include: attendance records, progress reports, and test and homework scores, if available. Please note: Instructors are not required to take attendance or provide progress reports and retain only those records which make up the final grade.)

Financial Aid Information (Information includes: required documentation or missing documents, financial aid awards such as Pell, MAP, and/or SRC Foundation Scholarships, Standards of Progress, and student loan information and amount.)

Other<strong>Other</strong>

Send Accuplacer Test Results to:
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Contacts to send Accuplacer Test Results:

Name of individual or institution

Fax

Address

City

State/Province

Zip/Postal

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