College Connect Locations
SUNO Campus: Miguel Devezin
Bashful Administration Bldg, Rm 210
Phone: 504-286-5007
Fax: 504-286-5213
Email: [email protected]
SUBR Campus: Carey Williams
Stewart Hall, Rm 107
Phone: 225-771-5630
Fax: 225-771-4954
Email: [email protected]
Office of Student Financial Aid & Scholarships
L. C. Barnes Administration Bldg., Rm A-43
3050 Martin Luther King, Jr. Drive
Shreveport, La 71107
Phone: (318)670-9221 Fax: (318) 670-6313 Email: [email protected]
RELEASE OF INFORMATION CONSENT FORM
Student: __________________________
SSN: (last four digits) _________
Date of Birth: _____________________
Telephone: __________________
The Family Educational Rights and Privacy Act (FERPA) is a Federal law that protects the privacy of
student education records. The law applies to all schools that receive funds under an applicable program
of the U. S. Department of Education.
Please check the option under which you, the student, request the SUSLA Office of Financial Aid &
Scholarships to apply your FERPA rights in connection with financial aid:
I do give authorization to discuss my financial aid records with my parent(s) that are indicated
on my most current Free Application for Federal Student Aid (FAFSA) and/or the following designated
parties.
I do give authorization to discuss my financial aid records to the following designated parties. I
am an independent student and my parent(s) are not listed on my most current FAFSA.
I do NOT give authorization to discuss my financial aid records. I am an independent student.
Name: ___________________________________
Relationship: ___________________________
Address: ____________________________________________________________________________
Telephone: ____________________ (home) ________________________ (cell)
Name: __________________________________
Relationship: ___________________________
Address: ____________________________________________________________________________
Telephone: ____________________ (home) ________________________ (cell)
_________________________________________
Student’s Signature
______________________________
Date
Southern University at Shreveport does not discriminate on the basis of race, color, national origin, gender, age or disability. Title IX Coordinator: Ms. Tilisha T.
Bryant, Administration Building, Room A-43, (318) 670-9210. Section 504 Coordinator: Ms. Jerushka Ellis, Fine Arts Building, Room C04 D, (318) 670-9473.
Revised 03/2016