Family Educational Rights and Privacy Act (FERPA) SUNY Orange Student Release Form Community College in the High School Program (CCHSP) The Family Educational Rights and Privacy Act of 1974, or FERPA, was designed by the federal government to protect the privacy of educational records. Under this policy, SUNY Orange officials are not permitted to give any information to a third party, including the student�s parents and/or guardians, about the student�s * Academic progress, including grades * Personal development or disciplinary matters However, it is often the student�s wish that information be released to the parent or other designated officials who may seek information from the College. If you wish to grant access to your information, this consent form must be signed and submitted to your high school guidance counselor, who will forward a copy to SUNY Orange. Name: ______________________________________ Student ID: ___________________________ (Please print) The following person(s) and/or institution(s) have my permission to review the records listed below upon written request. Please check box(es). * High School, ________________________________, for the purpose of maintaining accurate student records. (list name) * Parent(s), guardian(s) or other persons, for the purpose of reviewing the accuracy of student records. Please list names: Relationship Information (check box): * Academic (grades, GPA, academic progress/status, enrollment & registration information, attendance records) * Other:______________________________________________________________________________ This consent shall remain in effect for the ___________ academic year. I may revoke it at any time, in writing by contacting my high school guidance counselor, who will notify SUNY Orange of the change. Student�s signature: ________________________________________ Date:_____________________________ I am revoking my consent to release information indicated above effective _____________________________. Student�s Signature: _________________________________________________________________________ Instructions for Guidance: Please direct any questions to the SUNY Orange CCHSP Coordinator at (845) 341-4760.