Family Educational Rights and Privacy Act

The Family Educational Rights and Privacy Act (FERPA) is a Federal law that protects the privacy of student education records. In accordance with FERPA guidelines, Lenoir Community College (LCC) is not able to provide confidential information pertaining to students without the written consent from student (FERPA Release Form) or the written request from parent/legal guardian (Parent Affidavit for Academic Information Form).

FERPA Release Form

First Name

Last Name

Date of Birth

Student ID or Last 4 of SSN

Check all that apply:

All Financial Aid Records (records include: status of file, award and disbursement of funds information, Satisfactory Academic Progress status, income information, and any other information contained in the application or financial aid file).

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

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 parking tickets, 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, 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. FERPA pertains to the release of records. Instructors are not required to have conversations about academic progress with anyone other than the student).

Other - Please specify

NOTE: Services for Students Disabilities records are considered medical records and are not covered under the FERPA rules. A separate release form must be obtained from this department.

The following individual(s) are authorized to access the information indicated above:

First Name

Last Name

Relationship

Other

The following individual(s) are authorized to access the information indicated above:

First Name

Last Name

Relationship

The following individual(s) are authorized to access the information indicated above:

First Name

Last Name

Relationship

Do you certify that the above information is correct?

Although I understand I am not required to release this information, I am giving my consent to Lenoir Community College to disclose these records. I also understand that this release remains in effect while I am a student at Lenoir Community College, unless I revoke my consent in writing and deliver it to the Student Services Office at Lenoir Community College.

Do you agree and certify that the above statement and all contents on this form are correct?

Please leave this field empty.