Upward Bound - FERPA Tracking Release Form
Upward Bound - FERPA Tracking Release Form
WHAT IS FERPA?
FERPA, the Family Educational Rights and Privacy Act of 1974, as Amended, protects the privacy of student educational records. It gives students the right to review their educational records, the right to request amendment to records they believe to be inaccurate, and the right to limit disclosure from those records.
FERPA RELEASE AUTHORIZATION
Completion of this form authorizes Upward Bound to access any postsecondary academic records available through the National Student Clearinghouse. Academic records regarding academic enrollment in postsecondary education may include postsecondary institutions attended, enrollment dates, enrollment status, and degree completion.
Any data gathered will be used exclusively for long-term tracking of Upward Bound participant postsecondary enrollment and completion rates, in accordance with mandated federal objectives for the grant per CFR 645.31(b)(1)(vi).
Data will be gathered via the National Student Clearinghouse and maintained for six years and six months after the student has graduated from high school.
The above information will be released with my full consent. I understand that this authorization remains in effect from today’s date until six years and six months after the student has graduated high school. It will be necessary to send a written letter to revoke this authorization prior to the expiration date, if I choose to end it sooner.
Student's Name
Student's Name
*
First
Last
Student's Birthdate
Student's Birthdate
*
/
MM
/
DD
YYYY
Student's SSN (last 4 digits)
*
Must be
4
characters.
Currently Entered:
0
characters.
Student's signature
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.
Parent/Guardian Name
Parent/Guardian Name
*
First
Last
Parent/guardian signature
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.