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Get Box 400204 , Carruthers Hall, Charlottesville, Va 22904-4204 Telephone: (434) 982-6000, Fax: (434)

Ghts and Privacy Act (FERPA) of 1974 is designed to protect the privacy of a student s educational records. These confidential records may include, but are not limited to, financial aid, scholarship and fellowship, and student account/billing information (the Information ). The Information will not be released to anyone other than the student without written consent from the student. By signing this form, the student authorizes university personnel to release the Information to the design.

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