IRB FERPA Release (Delay)

The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. FERPA affords students certain privacy rights regarding their education records. Those rights and key definitions are summarized here; for more-detailed information about FERPA, visit ed.gov/ferpa/. In accordance with FERPA, Farmingdale State College must obtain written consent from a student before releasing the educational records of that student for research purposes. Such written consent must specify the records to be released, state the purpose of the release, and identify the party or class of parties to whom release may be made. Please complete the form below to give consent.

Student's First Name

Student's Last Name

RAMID

I, the undersigned, hereby give my written consent to Farmingdale State College, State University of New York, to release the following education records and/or any information contained therein.

Please identify specific records:

Purpose of release:

To [person(s) to receive information]:

Last Name

First Name

Middle Initial

Relationship to Student

Researcher's Email

I understand that this authorization will remain in effect until I decide to change it. By signing below, I give consent for the College to disclose the records listed above to the researcher listed above.

Sign Here (print first and last name)

IRB FERPA Release (Delay)

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