Title IX Records Release Authorization (FERPA)

⚠️ THIS FORM IS NOT FOR FERPA PROXY ACCESS ⚠️

Marshall University - TITLE IX CASE-SPECIFIC RECORDS RELEASE AUTHORIZATION Read Before Completing This Form Do not use this form if you are trying to give a parent, spouse, family member, or other person ongoing access to your academic records through FERPA Proxy. This is NOT a FERPA Proxy Authorization Form. This form is only for authorizing the Marshall University Title IX Office to release records related to a specific Title IX matter to a specifically identified person or entity. If you want to establish FERPA Proxy access: Log in to MyMU. Select MILO. Open the Information Release tab. Complete the FERPA Proxy forms there. Using this form will NOT create a FERPA Proxy account and will NOT provide anyone with ongoing access to your academic records, grades, registration information, financial information, or other student records. For assistance with FERPA Proxy access, contact: Kat Smith Director of Student Advocacy and Accountability Email: file1@marshall.edu Phone: 304-696-6833

⚠️ THIS FORM IS NOT FOR FERPA PROXY ACCESS ⚠️

TITLE IX CASE-SPECIFIC RECORDS RELEASE AUTHORIZATION

About this FERPA Release Form: The Marshall University FERPA Authorization to Release Information Form allows a student to give written consent for Marshall University Title IX Office to share the student's educational records with specific individuals or entities for a defined purpose, such as a Title IX matter. This form is case-specific and does not grant ongoing access to records. Students can choose which records to release and revoke consent at any time (though records already shared remain released).

Important Information About This Form: By completing this form, you are authorizing the Marshall University Title IX Office to release your educational records only in connection with a Title IX matter to the individuals or entities you listed.

If you intended to set up a FERPA Proxy (to allow parents or others to access your academic records), please do not use this form. Instead, log in to MyMU → MILO → Information Release tab and complete the Proxy forms there. Detailed instructions are available on the Marshall University Student Affairs FERPA webpage (url: https://www.marshall.edu/student-affairs/ferpa/) under “Instructions for Students” and “Instructions for Parent/Proxy.” For questions about FERPA Proxy forms, contact: Kat Smith, Director of Student Advocacy and Accountability Email: file1@marshall.edu | Phone: 304-696-6833

Information about You

Your Name(Required)

First Middle Last

Student ID Number(Required)

Provide your Marshall University ID Number.

Preferred Name / Pronouns(Required)

List your preferred name and pronouns.

Date of Birth(Required)

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Records or Types of Records Authorized for Release(Required)

Authorize release of all records

Authorize release of specific records identified below

Description of records covered by this authorization(Required)

Please provide a brief description of the scope of records covered by your selection above. If you selected all records, write “All records.” If you selected specific records, list those records or types of records below.

The Person/Entity Receiving Records:(Required)

Email Address of Person/Entity Receiving Records(Required)

Email Address Confirm Email Address

Address of Person/Entity Receiving Records(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Name(Required)

First Middle Last

REMINDER: By completing this form, you are authorizing the Marshall University Title IX Office to release your educational records only in connection with a Title IX matter to the individuals or entities you listed.

REMINDER: If you intended to set up a FERPA Proxy (to allow parents or others to access your academic records), please do not use this form. Instead, log in to MyMU → MILO → Information Release tab and complete the Proxy forms there. Detailed instructions are available on the Marshall University Student Affairs FERPA webpage (url: https://www.marshall.edu/student-affairs/ferpa/) under “Instructions for Students” and “Instructions for Parent/Proxy.” For questions about FERPA Proxy forms, contact: Kat Smith, Director of Student Advocacy and Accountability Email: file1@marshall.edu | Phone: 304-696-6833

Thank you for taking the time to fill out the Marshall University - Family Educational Rights and Privacy Act Authorization to Release Information Form.

Title IX Records Release Authorization (FERPA)

⚠️ THIS FORM IS NOT FOR FERPA PROXY ACCESS ⚠️

⚠️ THIS FORM IS NOT FOR FERPA PROXY ACCESS ⚠️

TITLE IX CASE-SPECIFIC RECORDS RELEASE AUTHORIZATION

Important Information About This Form: By completing this form, you are authorizing the Marshall University Title IX Office to release your educational records only in connection with a Title IX matter to the individuals or entities you listed.

Information about You

REMINDER: By completing this form, you are authorizing the Marshall University Title IX Office to release your educational records only in connection with a Title IX matter to the individuals or entities you listed.

Thank you for taking the time to fill out the Marshall University - Family Educational Rights and Privacy Act Authorization to Release Information Form.

Important Reminder: Online Reporting Strongly Preferred

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