Student Authorization to 
Release Education Records To Parents/Guardians

 

Student’s Name:  _________________________________________________________

 

Item(s) of information to be released:  _________________________________________

 

________________________________________________________________________

 

The information may only be released to the following person(s):

 

________________________________________________________________________

 

________________________________________________________________________

 The purpose of this disclosure is to: ____________________________________________

I hereby grant authorization to The Catholic University of America to release my above-referenced education records to the party or parties listed on this form.  I understand that I am entitled to a copy of the records so disclosed upon request.

 

_____________________________________________      ________________________

                    Student’s Signature                                                                   Date

 

Please return this form to the Registrar's Office, Room 10 in McMahon Hall.

Source:  34 C.F.R. § 99.30

 

 

 

form updated 10/17/07 PTH