FERPA Form

Student Name:

MVNU ID#:

Email:

Create a Password:

Any combination of letters only. We will only disclose information to people you list below if they know your password.

I do not give permission to disclose information to anyone at this time.

By signing this form, I give the below designated individual(s) permission to discuss the below designated information about me to MVNU employees. This information may be disseminated to the designated individual(s) while I am enrolled at MVNU or until I revoke this permission in writing at the University Registrar’s Office.

Date:

Individual(s) that MVNU may disclose information to while I am enrolled:

Name:

Relationship to you:

Areas of Permission to Disclose:

A

C

F

H

Contact Info (email or phone):

Name:

Relationship to you:

Areas of Permission to Disclose:

A

C

F

H

Contact Info (email or phone):

Area of Permission for Disclosure

Item A: Academic Information
Grants permission for MVNU personnel to discuss academic issues such as grades, academic status (probation, dismissal, etc.) and class attendance with the individuals listed.
Item C: Chapel Attendance Information
Grants permission for the Chapel personnel to discuss issues such as spiritual life attendance, credits, etc. with the individuals listed.
Item F: Financial Information
Grants permission for Student Accounts and Financial Aid personnel to discuss financial issues such as financial aid, account balances, payments due, etc. with the individuals listed.
Item H: Housing Information
Grants permission for Residence Life or Student Success personnel to discuss housing information. This can often include information on roommate issues, adjustment to college life, general well-being and patterns of eating/sleeping.

Student Consent to Disclosure of Information