2023-2024 FERPA Authorization

2023-2024 FERPA Authorization

(Release of Information)
Campus Location*
FERPA guidelines, Heritage University may disclose basic information about me that is generally not considered harmful or an invasion of privacy without my consent, which is released as "Directory Information". This is notification that I do not want to be included in Heritage University Directory Information and that my education records should not be disclosed without my written consent, except as required by law.

If you are granting permission for our office(s) to discuss your status with other designees, please complete this form and return it to the Student Services Office. IF YOU DO NOT RETURN THIS FORM TO HERITAGE UNIVERSITY, WE WILL NOT RELEASE ANY FINANCIAL OR STUDENT DATA WITH ANYONE OTHER THAN YOU.
Student Information
Name

First NameLast Name
SSN
Student ID
Email
example@example.com
Phone Number
Please enter a valid phone number.
Permissions
Check the permissions you wish to grant the individual stated below:

FINANCIAL DATA (Accounts Receivable - Student financial information such as tuition, fees, payments, check availability, etc. Financial Aid - File status, award types and amounts, disbursement status, etc. Work Study - Employment information such as pay rate, start/end dates, job title, employer, supervisor name, etc.)STUDENT DATA (Registrar - Student records information such as transcripts. Admissions/Advising Center - Registration and degree advising, etc.)
Release Effectiveness

Check the release effectiveness you are granting the individual listed below:

	Check	Date
This release is effective until the following date:
This release is in effect as long as I am a student at Heritage University.

Release of Information
I hereby give Heritage University staff permission to discuss my files with:
Name of Individual

First NameLast Name
Relationship to Student
Student Signature

Clear
Date

MonthDayYear
Date
HAVE QUESTIONS ABOUT YOUR FINANCIAL AID?

Financial Aid Office Contact Information

Address: ATTN: Financial Aid Office 3240 Fort Rd., Toppenish, WA 98948 | Phone: (509) 865-8502 | Email: financial_aid@heritage.edu
Should be Empty:

Student Information