For Use by Parent or Eligible Student to Grant Consent

I hereby grant the permission for [name of person] ___________________ to accompany me today during my review of my/my child's education records. I understand that in doing so, the information maintained in the education records, otherwise protected by [Federal and state laws], may be disclosed with my consent to the above named.

Signature: _____________________________

Name: _____________________________

Date: _____________________________

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For Use by Accompanying Person as Affidavit of Non-Disclosure

In accompanying the above signed parent/guardian on this date during his/her review of the education records of [name of student], I will be given access to confidential information maintained in the education records of the named student. I understand that this information is protected under [FERPA and state laws, where applicable]. I hereby acknowledge that I fully understand that the intentional release by me of this information to any unauthorized person could subject me to [penalties where applicable] imposed by [Federal and state laws].

Signature: ___________________________________

Name: ___________________________________

Date: ___________________________________

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For official use only

Staff initials: ____________________ Date: _____________________

 
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