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