FAMILY EDUCATIONAL RIGHTS & PRIVACY
ACT (FERPA)
STUDENT LOAN INFORMATION RELEASE FORM
If
you wish specific loan information to be released to another person (i.e.:
parent or spouse), per Federal Regulations you must provide written
authorization. Release authorization
forms are available at our web site. http://www.controller.jhu.edu/depts/loans/student
AUTHORIZATION
TO RELEASE INFORMATION
q I
HEREBY AUTHORIZE THE STUDENT LOAN OFFICE, JOHNS HOPKINS UNIVERSITY TO RELEASE
INFORMATION REGARDING MY STUDENT LOANS TO:
(please print or type)
_________________________________________________________
(name
& relationship - also include address & phone #)
_________________________________________________________
(name & relationship -
also include address & phone #)
q
I AUTHORIZE THAT A FACSCIMILE COPY OF MY
SIGNATURE BE ACCEPTED. I WILL FORWARD AN ORIGINAL COPY FOR MY FILE
OR
q I
DO NOT WANT INFORMATION RELEASED TO ANYONE OTHER THAN MYSELF. (Please note that if you check this, your
parents or spouse CANNOT get information on your loan if they call us.)
PLEASE
COMPLETE THE FOLLOWING INFORMATION:
BORROWERS NAME:
_____________________________________________________
SOCIAL SECURITY NUMBER: ______ \ _____ \ ________
Was this correspondence sent to an address where
you want all your mail sent?
___YES ___NO
If not please give us your mailing address:
_______________________________________________________________
_______________________________________________________________
HOME PHONE: (_____) _____-________ WORK PHONE:
(_____) _____-ญญญญญญญญญญญ________
EMAIL ADDRESS ___________________________
Name of current employer
_________________________________
Are you currently enrolled at least half time as
a student? ______
Name of school_____________________________
________________________________________ ______________________
Borrowers
Signature Date
Return
form to Student Loan Office, JHU, 1101 E. 33rd St. Suite B200,
Baltimore, MD 21218 phone 800-648-1245
FAX
443-997-4703