OFFICE OF CAMPUS LIFE AND STUDENT AFFAIRS
FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA) RELEASE
The Family Educational Rights and Privacy Act (FERPA) is a federal law that prohibits Drew University from
releasing a student’s education records to third-parties without the student’s prior written consent except
under certain circumstances identified in the University’s policies. By completing this form, a student hereby
gives his/her consent to the University’s release of his/her education records according to the terms described
below:
Name of Student: ___________________________________ Drew ID Number: _______________________
Date of Birth: ______________________________________
I, the undersigned, hereby authorize Drew University to release the following education records and
information (identify records or type of records):
____________________________________________________________________________________________
____________________________________________________________________________________________
To the following individual(s)-(Name and address of person/agency/institution to receive information):
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
For the following purpose(s):
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
I understand and agree that: (1) I have the right to review my records upon request; (2) I have the
right not to consent to the release of my education records; and (3) that this consent shall remain in
effect until revoked by me, in writing, and delivered to the Office of Campus Life and Student Affairs
at Drew University, but that any such revocation shall not affect disclosures previously made by
Drew University prior to the receipt of any such written revocation.
______________________________________
_____________________________________
Student Signature
Date
This information is released subject to the confidentiality provisions of appropriate state and federal laws
and regulations which prohibit any further disclosure of this information without the specific written
consent of the person to whom it pertains, or as otherwise permitted by such regulations.