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DRAKE UNIVERSITY

STUDENT EDUCATION RECORDS RELEASE (FERPA)

Print this form, complete it and present it to the appropriate office. 

 

From:                                                                           Drake ID #                              

(Print Full Name of Student)

To:       Drake University

 

Re:        Release of My Education Records by ______________________________

                                                                                                (Office)

Note: A separate form is required for each office from which information is requested)

 

If contacted, please release the following education records pertaining to me:

 

                                                                                                                                   

 

                                                                                                                                   

                                    (Specify the records to be disclosed)

 

to the following persons/entities (include contact information):

 

                                                                                                                                   

 

                                                                                                                                    .

                 (Identify the party or class of parties to whom the records may be released)

 

for the following time period: _______________ to ____________________

 

The purpose of this disclosure may be described as follows:

 

                                                                                                                                   

 

                                                                                                                                    .

                                    (State the purpose of the disclosure)

 

This release may be revoked in writing at anytime

           

                                                                       

Student Signature

 

                                                                       

Date

 

Note: All requests for grade information will be directed to the student’s respective college or school.