Release Of Information

Release of Information As a student at Charter Oak State College, you are entitled, in compliance with the Federal Family Education Rights and Privacy Act of 1974 (FERPA), to have all information concerning your educational records (i.e., academic, financial aid, billing data) kept confidential. This information cannot be discussed with anyone (parent, spouse, relative, sponsor, organization, etc.) without your written permission. For this reason, it is necessary for you to sign a release of information form if you wish to waive this right and permit College staff to discuss this information with people indicated below:

I give College staff permission to discuss my education records with: _____________________________________________________________________ Hi there. HOW ARE THINGS GOING? _____________________________________________________________________ so please let me know yes or now so that we can move to iy sooner or later _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ I understand that this information will not be given to anyone else without my signature. Further, I understand that I can rescind this permission at any time by informing the College, in writing, of this change.

Ruth Demosthenes __________________________________ _XXX – XX - __________

Student’s Name (Please PRINT)

Last Four Digits of Social Security

__________________________________ _____________________ Signature of Student

Date

Return this form to the Registrar’s Office Degrees Without Boundaries _________________________________________________________________________________ 55 Paul J. Manafort Drive, New Britain, CT 06053-2142 • Telephone: 832-3800 • Fax: (860) 832-3999 E-mail:[email protected] • Website: www.charteroak.edu