FERPA Release
I, ____________________ understand that in order for me to participate as a practicum
student or intern with _____________________, there may be a possibility of releasing
(name of site)
Student information that is protected under the Family Educational Rights and Privacy
Act (FERPA). By my signature below, I attest that I give permission to UMKC to share
required student records with ________________________.
(name of site)
Name____________________________________________
Print and Signature
Date______________