FERPA Release Form Header Image

Family Educational Rights and Privacy Act (FERPA) Release Form

The Family Educational Rights and Privacy Act of 1974 (FERPA) protects the privacy of student records by requiring prior written consent before disclosing personally identifiable information to a third party. It applies to colleges and universities that receive funding from the federal government. Records created and maintained by Missouri Baptist University are considered to be education records and may not be disclosed without the student's consent.

First, Last
Ex. 1122334@mobap.edu
Type of Information to Release*
Decline permission for MBU to discuss any financial or academic affairs with anyone but myself.*

Release Information To

Name - 1*
Add Another Contact?*
Name - 2*

Student Signature

Unless designated otherwise, by signing this form you are giving permission to disclose personally identifiable information to the person(s) listed above (unless permission was declined). This will remain in effect until you, the student, rescind the permission in writing.

Use your mouse or finger to draw your signature above
Date*

Business Office Signature

Use your mouse or finger to draw your signature above
Date*
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