STUDENT INFORMATION RELEASE AUTHORIZATION

Instructions: Complete and submit this form to authorize the release of your educational records or directory information to a designated third party. Be sure to include all required fields. Incomplete forms will not be processed.

Student Information

Name (Last, First, Middle Initial)

GGU ID# or SS# (Last 4 Digits Only)

Email Address

Daytime Phone

Third-party Designee

Name (Last, First, Middle Initial)

Relationship to Student

Email Address

Current Address

Purpose of Release

Other Type of Information

Authorization

In accordance with the Family Educational Rights and Privacy Act (FERPA) of 1974, Golden Gate University will only disclose confidential information from a student’s education records to parents, spouses, sponsors, or other third parties if the University has written consent from the student on file.

Please note: This release form will remain valid throughout the student’s enrollment at Golden Gate University, unless it is explicitly revoked by the student in writing.

By checking this box, I consent that Golden Gate University may disclose and discuss confidential information from my education record with the individual listed above, for the purpose of release as indicated in this form.

Contact Information