Consent to Release Student Information

The Family Educational Rights and Privacy Act (FERPA) protects the privacy of your education records. Student Accessibility Services (SAS) takes all appropriate steps to comply with FERPA. With limited exceptions, SAS needs your consent before it can release information from your student education records. One notable exception is that the law allows SAS to disclose information from your education records, without consent, to school officials with a legitimate educational interest.

If you would like SAS to disclose information about you to individuals or agencies outside the University, please complete the following:

This consent does not cover records received from the UTRGV Counseling Center. Those records must be requested directly from that office.

In signing below, I understand that the above information may be released orally or in the form of copies of written records, as preferred by the requestor. I have a right to inspect any written records released pursuant to this Consent (except for parent’s financial records and certain letters of recommendation for which the student waived inspection rights). I may revoke this Consent by written request. Signed,

FERPA Privacy First Name (Required) Format: First Name Last Name (Required) Format: Last Name Student ID (Required) Format: UTRGV ID Number Email (Required) Format: John.Smith@utrgv.edu

I, hereby grant my consent to SAS to provide information from my SAS records to: TWC (DARS)
Parent/Guardian/Spouse
Other, Specify

If other, please specify Please include Vocational Rehab Counselor: Name of Parent/Guardian/Spouse SAS records other, specify

The type of information that may be released under this consent is as follows: Accommodations information
Academic information (grades, academic standing, etc.)
Other, specify.

If other, specify

The University of Texas Rio Grande Valley

Student Accessibility Services Office of Student Life and the Dean of Students

Consent to Release Student Information