FA78-16/17(09/15)
Family Educational Rights and Privacy Act (FERPA) Release Form
2016-17
_________________________
Student Name
_____________________
UW-L Student I.D. #
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 the Financial Aid Office and the Cashier’s Office are
considered to be education records and may not be disclosed without the student’s consent. In
order for our office to be able to discuss your information with your parents, spouse, or other
persons who you designate, you must authorize the Financial Aid Office and the Cashier’s
Office to release personally identifiable financial aid information. This will remain in effect for
the academic year indicated above.
I authorize the University of Wisconsin-La Crosse Financial Aid Office and Cashier’s
Office to release my financial aid information which includes, but is not limited to,
materials missing from my financial aid file, status of my financial aid file, income
information, types and amounts of awards, tuition balances, university billing
information, and refund balances, to the following person(s):
_________________________
Name
_____________________
Relationship to you
_________________________
Name
_____________________
Relationship to you
_________________________
Name
_____________________
Relationship to you
_________________________
Student Signature
_____________________
Date
FINANCIAL AID OFFICE
215 Graff Main Hall
1725 State St. | La Crosse, WI 54601 USA
phone 608.785.8604 | fax 608.785.8843
finaid@uwlax.edu
www.uwlax.edu/finaid
Surround yourself with UW-La Crosse
An affirmative action/equal opportunity employer