C:\Users\David Martinez\Desktop\logo.png


Student Information Release Authorization 

Information To Be Completed By Student 
(You must PRINT this information legibly. All field are required.) 





1.Student Name:__________________________________________________________________2.EMPLID #:____________________ 
Last First Middle Initial 

. I would like to review and obtain copies of my financial aid records listed below. Note: I understand that I may not have access to my 
parents’ financial records without their written consent. 


________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________ 



. I would like to have information pertaining to my financial aid released to the third party listed below. [If this information is to be 
supplied on another agency’s form, please attach a copy.] 




1.Name or Agency: _______________________________________________________________________________________
2.Street Address: _________________________________________________________________________________________
3.City, State & Zip: ________________________________________________________________________________________
4.Phone Number: _________________________________________________________________________________________


Release Authorization 

Under federal legislation, namely the Family Educational Rights & Privacy Act of 1974 (FERPA), and City University of New York 
policy, I understand that my student aid records cannot be released to a third party without my permission. I hereby authorize the 
Financial Aid Office at Lehman College to release information from my student aid records to the agency or individual named above. 



_____________________________________________________ ______/_______/________ 

 Signature Date 



*********************************************************************************************************************** 

PLEASE CHECK ONE (If applicable): 



. Please mail this information directly to third party listed above. 
. Please mail it to me at the following address: 


________________________________________________________________________________________________________________
________________________________________________________________________________________________________________ 

************************************************************************************************************************ 

For College Use ONLY 

(DO NOT WRITE BELOW THIS LINE) 





. Documents given to student 
. Documents mailed or faxed 


Financial Aid Signature: ____________________________________________ Date Processed: ______/________/_______