Do not print the form and fill it out by hand.  
 

Enter all the required information online, use the "Print and Sign" button at the bottom of the form to generate the official PDF copy.
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The official copy will have a barcode in the lower left corner and a signature line at the end of the form.
 

After you print and sign the form, bring the form to the Enrollment Services Office on the first floor of Lynnwood Hall, OR fax the form to 425-640-1159, OR mail the form to: 
 
Enrollment Services 
Edmonds Community College 
20000 68th Ave W 
Lynnwood, WA 98036 

Student Release of Records – FERPA Authorization Form
(Family Educational Rights and Privacy Act) 
 Student Name     Last: (Surname):      First:      M.I.: 
 Student ID Number:    -- Help  Birthdate:  //   MM/DD/YYYY
 Year/Quarter:    Help  Social Security Number: -- Optional
TO BE FILLED OUT BY THE STUDENT ONLY.
I hereby authorize Edmonds Community College to release my educational records, as indicated below, for the purpose of:
  Academic Assistance       Payment of Tuition      Verification of Enrollment/Progress
  Other:  
 (If ‘other’, please explain why you wish to release these records)

 Check each checkbox below to indicate which records you wish to make available:
 All Financial Aid Records (records include: status of file, award and disbursement of funds information, Satisfactory Academic Progress status, income information, and any other information contained in the application or financial aid file).
 All Academic/Transcript Records (records include: transcripts, admission and registration information, schedule information, assessment test scores, Satisfactory Academic Progress status, residency information, and any other documentation contained in the academic records).
 All Student Account Records (records include: amounts due for tuition and fees, sources of payment for tuition and fees, refund information, records hold information as it relates to parking tickets, library fines, financial aid repayments and any other accounts receivable information contained in student account records).
 Instructor/Classroom Records (records include: attendance, progress reports, test and homework scores if available. Please note: instructors are not required to take attendance or provide progress reports, and retain only those records which make up the final grade. FERPA pertains to the release of records. Instructors are not required to have conversations about academic progress with anyone other than the student).
 Other (Please Specify)
 Please Note: Counseling Center and Services for Students with Disabilities records are considered medical records and are not covered under FERPA rules. A separate release form must be obtained from these departments.
The following individual(s) are authorized to access the information indicated above (PLEASE PRINT FULL NAME)
Spouse  Mother/Stepmother 
Agency  Father/Stepfather 
Other (Specify name and relationship) 
Although I understand I am not required to release this information, I am giving my consent to Edmonds Community College to disclose these records. I also understand that this release remains in effect for one calendar year from the date signed, unless I revoke my consent in writing and deliver it to the Enrollment Services Office at Edmonds Community College.
PLEASE NOTE: A clear photocopy of your picture ID is required to verify authenticity of this release. Enrollment Services can make a copy if you deliver this form in person. Otherwise, please make sure a copy is attached before turning this form in.
 Signature of Student _________________________________________________     Date 
 FERPA pertains to the release of records only. It does not give others the right to act on your behalf or to change your records.
 Original must be kept on file in the Enrollment Services Office. A copy will be sent to the student. Upon request, a copy will be sent to the appropriate campus offices for their files.
  
 
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 Please print the PDF and sign
 
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