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Seminary
Info
Family Education Rights & Privacy Act - FERPA Consent Form
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Student Information
First Name*
Middle Initial*
Last Name*
Student ID #*
Birthdate*
Birthdate*
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Email*
Permanent Address*
Permanent Address*
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Street
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Postal Code
Student's Dependency Status
You have the right to consent to whom your education record is released. Grace College and Seminary does not assume the dependency status of our students and thus requires the written consent of the student to release financial and academic information to a student’s parents. Under the Family Educational Rights and Privacy Act (FERPA), Grace College and Seminary is permitted to disclose information from your education records to your parents if one or both of your parents claim you as a dependent for federal tax purposes. Please indicate whether your parent(s) claim you as a tax dependent.
Yes, I certify that my parent(s) claim me as a dependent for federal income tax purposes.
No, I certify that my parent(s) do not claim me as a dependent for federal income tax purposes.
I do not know if my parent(s) claim me as a dependent for federal income tax purposes.
In place of a manual signature, please type your full name as your electronic signature:*
Student's Consent
If you are not claimed as a dependent or you do not know whether you are claimed as a dependent for federal income tax purposes, but you agree that Grace College and Seminary may disclose information from your education records to your parent(s) or others, please sign the following consent. You will not be denied educational services from Grace if you decline to provide consent.
I would not like my Student Account, Financial Aid, Academic, or Student Affairs/Conduct information to be shared with anyone.
I would like my Student Account, Financial Aid, Academic, and/or Student Affairs/Conduct Information to be shared with one or more people. I have listed their names and contact information below.
I consent to the disclosure of the following personally identifiable information from my education records to my parent(s) or others, for reasons determined by Grace College and Seminary as appropriate. This authorization will remain in effect until such time as I revoke or revise this consent.
In place of a manual signature, please type your full name as your electronic signature:*
Authorized Individuals:
Individual 1
First and Last Name
Phone Number
Email
Relationship*
Mother
Father
Spouse
Other
Please specify:*
Information to be released (check all that apply):*
Information to be released (check all that apply):*
Student Account
Financial Aid
Academic
Student Affairs/Conduct
Other
Please specify:*
Individual 2
First and Last Name
Phone Number
Email
Relationship*
Mother
Father
Spouse
Other
Please specify:*
Information to be released (check all that apply):*
Information to be released (check all that apply):*
Student Account
Financial Aid
Academic
Student Affairs/Conduct
Other
Please specify:*
For the complete FERPA policy, see the
Student Right to Know
page of the Grace College website.
This completed form is submitted to the Grace College Student Services Hub.
Submit