OC EAC General Consent to Release

Oxnard College - Educational Assistance Center
CONSENT TO RELEASE
Student’s Name *
900# *
VCCCD ID Number
DISCLOSURE TO PARENTS/GUARDIANS/OTHERS
As allowed by federal regulations, the Family Educational Rights & Privacy Act (FERPA), Oxnard College EAC releases information contained in a student’s educational record to a student’s parents/guardians (both custodial and non-custodial) if the student gives consent. If you wish your parent/guardian/Others to have access to your information, please fill in the following information:

Please list Parent(s) or Guardian(s) or Other individuals and your relationship to them:
Name of Parent/Guardian/Other:
Relationship:
i.e. "Mom", Dad", "Sister", "Friend", etc.
Please Initial:
Student's Initials
Name of Parent/Guardian/Other:
Relationship:
i.e. "Mom", Dad", "Sister", "Friend", etc.
Please Initial:
Student's Initials
Name of Parent/Guardian/Other:
Relationship:
i.e. "Mom", Dad", "Sister", "Friend", etc.
Please Initial:
Student's Initials
Name of Parent/Guardian/Other:
Relationship:
i.e. "Mom", Dad", "Sister", "Friend", etc.
Please Initial:
Student's Initials
Name of Parent/Guardian/Other:
Relationship:
i.e. "Mom", Dad", "Sister", "Friend", etc.
Please Initial:
Student's Initials
Name of Parent/Guardian/Other:
Relationship:
i.e. "Mom", Dad", "Sister", "Friend", etc.
Please Initial:
Student's Initials
THIS AUTHORIZATION SHALL REMAIN IN EFFECT UNTIL REVOKED IN WRITING BY THE UNDERSIGNED
Student or Parent/Guardian Signature*

Clear
Date *

MonthDayYear
Today's Date
Should be Empty:

Oxnard College - Educational Assistance Center

CONSENT TO RELEASE

DISCLOSURE TO PARENTS/GUARDIANS/OTHERS

THIS AUTHORIZATION SHALL REMAIN IN EFFECT UNTIL REVOKED IN WRITING BY THE UNDERSIGNED