Release for Letters of Recommendation
The Family Educational Rights and Privacy ACT (FERPA) afford certain rights to students concerning the privacy of, and access to, their education
records. Students may choose to complete and submit this form to the Registrar allowing the release of their education records to specified third
parties. Please note that while this form authorizes the University of Alabama at Birmingham to release education records to third parties, it does not
obligate the university to do so. The University reserves the right to review and respond to requests for release of education records on a case-by-case
basis. For additional information, visit UAB's FERPA Information page at https://www.uab.edu/registrar/ferpa or the U.S. Dept. of Education's
website at https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html. Guidelines for Postsecondary Institutions for Implementation of the Family
Educational Rights and Privacy Act of 1974 as Amended, Revised Edition 1998, Richard A. Rainsberger, American Association of Collegiate
Registrars and Admissions Officers
I, ________________________ authorize the following release:
(Student’s Name )
1) Records which may be disclosed:
o Any transcript information
o Major and
degree sought
o GPA and specific course information
o Other (specify): ___________________________________________________
2) Purpose of the disclosure:
o Employment Recommendation
o Graduate or professional school recommendation
o Other (specify): _____________________________________________________
3) Parties to whom the disclosure can be made:
Name: _____________________________________________________
Address:
_____________________________________________________
City: _________________________ State: ___ Zip: ____________
Email: ______________________________________________________
Name: _____________________________________________________
Address: _____________________________________________________
City: _________________________ State: ___ Zip: ____________
Email: _______________________________________________________
Signature: _____________________________________________________________ Date: ____________________________
This information is released subject to
the confidentiality provisions of appropriate state and federal laws and regulations which prohibit any further
disclosure of this information without specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations.
1300 University Blvd. CH 117A, Birmingham, AL 35294 | Phone (205)934-8228 | Fax (205) 975-3700 | [email protected]
09/08/2023
