№ lp_2_3_22525
File format: docx
Character count: 6742
File size: 42 KB
Year:
2026
Region / City:
United States
Document Type:
Consent Form
Institution:
School District and Health Care Provider
Audience:
Parents/Guardians of Students
Student Name:
[Redacted in template]
Student DOB:
[Redacted in template]
Purpose:
Authorize sharing of educational and health information between school and healthcare team
Revocation:
Can be revoked at any time in writing
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2026
Region / City:
United States
Topic:
Education Rights
Document Type:
Policy
Institution:
Penn State University
Author:
Unknown
Target Audience:
University staff and faculty
Period of Action:
Ongoing
Approval Date:
Unknown
Modification Date:
Unknown
Note:
Year
Organization / Institution:
Columbus State Community College
Target Audience:
Contractors, College Staff
Year:
1974
Region / City:
Westminster College
Subject:
Family Education Rights and Privacy Act (FERPA)
Document Type:
Authorization Form
Institution:
Westminster College
Target Audience:
Students of Westminster College
Effective Period:
Indefinite (unless otherwise revoked)
Approval Date:
Not specified
Modification Date:
Not specified
Context:
A form for students at Westminster College to authorize the release of their education records to designated individuals under FERPA guidelines.
Year:
2023
Region / city:
United States
Topic:
Education
Document type:
Policy
Organization:
U.S. Department of Education
Author:
U.S. Department of Education
Target audience:
Postsecondary institutions, eligible students
Effective period:
Ongoing
Approval date:
N/A
Amendment date:
N/A
Year:
2023
Region / City:
Hickman County, Kentucky
Topic:
Education, Privacy, Legal Responsibilities
Document Type:
Acknowledgement of Responsibilities
Institution:
Hickman County Schools
Author:
Christel Nall
Target Audience:
Volunteers in Educational Institutions
Effective Period:
Indeterminate
Approval Date:
N/A
Date of Amendments:
N/A
Year:
1974
Jurisdiction:
United States
Topic:
Student privacy and education records
Document type:
Federal law summary
Issuing body:
U.S. Department of Education
Office:
Family Policy Compliance Office (FPCO)
Target audience:
Parents, eligible students, school officials
Key provisions:
Right to access, request correction, control disclosure of education records
Legal references:
20 U.S.C. § 1232g; 34 CFR Part 99
Contact information:
1‐800‐USA‐LEARN; Family Policy Compliance Office, 400 Maryland Avenue SW, Washington, D.C. 20202‐8520
Notification requirement:
Annual notification to parents and eligible students of FERPA rights
Disclosure exceptions:
School officials with legitimate educational interest, other schools, auditing officials, financial aid parties, research organizations, accrediting bodies, judicial orders, health and safety emergencies, juvenile justice authorities
Summary:
Federal legal text detailing student rights to access and control educational records, obligations of schools regarding disclosure, and procedures for amending records.
Year:
1974
Region / City:
Alamo Colleges District
Topic:
Family Educational Rights and Privacy Act
Document Type:
Consent Form
Institution:
Northeast Lakeview College
Author:
Legal Services Department
Target Audience:
Students at Alamo Colleges
Effective Period:
Ongoing, unless revoked
Approval Date:
1974
Amendment Date:
Not specified
Year:
2013
Region / city:
United States
Subject:
FERPA and privacy in school disciplinary actions
Document type:
Legal/Policy
Organization:
SPLC
Author:
Frank LoMonte
Target audience:
Public, education professionals, legal experts
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Organization:
Common Application
Related regulation:
Family Educational Rights and Privacy Act (FERPA)
Document type:
Instruction guide
Subject:
Completion of FERPA release authorization in the Common Application
Process described:
FERPA agreement completion before submitting a Common Application
Platform:
Common Application online account
Associated system:
Naviance
Intended audience:
Applicants using the Common Application
Required action:
Reading and signing the FERPA agreement and selecting release authorization options
Key elements:
Release Authorization, waiver decision for access to supporting documents, electronic signature
Year:
2026
Institution:
Mount St. Joseph University
School:
School of Health Sciences
Document Type:
Consent form / Waiver
Subject:
Student participation recordings, educational activities
Audience:
Students, faculty, volunteers
Purpose:
Disclosure of classroom recordings for educational and research purposes
Legal Basis:
Family Educational Rights and Privacy Act (FERPA)
Revocation Policy:
Written notice required to revoke consent
Liability:
University not responsible for unauthorized disclosure by third parties
Institution:
Utica College
Law Referenced:
Family Educational Rights and Privacy Act (FERPA)
Document Type:
Institutional guidance summary
Subject:
Privacy and handling of student education records
Purpose:
Key principles for protecting and disclosing student education records
Audience:
Utica College employees
Region / Country:
United States
Institutional Office Referenced:
Office of the Registrar
Contact Phone:
792-3393
Referenced Systems:
Banner Student Information System
Related Resources:
Utica College Registrar website; Undergraduate and Graduate Catalogs (Academic Regulations section)
Directory Information Items:
Student name; hometown; major field of study; local address and telephone number; permanent address and telephone number; e-mail address; cell phone number; academic level; residency status; registration status; participation in recognized sports or activities; athletic team weight and height; dates of attendance; degrees or awards received and dates; photographs; date and place of birth; most recently attended educational institution
Revision Date:
03/09/2010
Year:
2012
Region / City:
United States
Topic:
Education Law
Document Type:
Conference Presentation
Institution:
University of North Texas System
Author:
Karin W. Rilley
Target Audience:
Business Office personnel, Educational administrators
Effective Date:
November 19, 1974
Date of Last Update:
June 21, 2012
Period of Applicability:
Ongoing
Approval Date:
August 21, 1974
Amendment Date:
N/A
Year:
2013
Region / City:
West Virginia University
Subject:
Education Records Disclosure
Document Type:
Consent Form
Organization / Institution:
West Virginia University, Office of Student Activities
Author:
West Virginia University
Target Audience:
Students at West Virginia University
Period of Validity:
Until student leaves university
Approval Date:
01/30/2013
Date of Changes:
N/A
Year:
N/A
Region / City:
N/A
Theme:
Research, Health Information, HIPAA Authorization
Document Type:
Template
Organization / Institution:
UW Medicine, Fred Hutchinson Cancer Center
Author:
N/A
Target Audience:
Research Participants, Legal Representatives
Effective Period:
N/A
Approval Date:
N/A
Revision Date:
N/A
Note:
Year
Topic:
Research
Document Type:
Consent Form
Note:
Version Date
Year:
2013
Region / City:
United States
Topic:
Health Information Privacy
Document Type:
Regulatory Guidelines
Organization / Institution:
Department of Health & Human Services
Author:
Department of Health & Human Services
Target Audience:
Covered entities, business associates, legal professionals
Period of Validity:
Ongoing
Approval Date:
January 25, 2013
Amendment Date:
Not specified
Note:
Year
Topic:
Business Associate Agreement, HIPAA Compliance
Document Type:
Agreement
Year:
2026
Region / City:
United States
Subject:
Health information privacy
Document type:
Privacy notice
Organization:
Physician practice
Author:
Privacy Officer
Effective date:
[insert effective date]
Legal reference:
45 C.F.R. § 164.520
Target audience:
Patients
Rights covered:
Access, amendment, accounting of disclosures, confidential communications, special privacy protections