ࡱ> CEBe bjbjhh |"ii WWWWWkkkk$k'by'{'{'{'{'{'{'8+-v{'W+++{'WW'+ WWy'+y'%h&``:5 %e''0'%d.?Rd. &d.W&4|d{'{'v'++++d.Y :  PAINE COLLEGE Office of Financial Aid Telephone: 706-822-8262 1-800-476-7703 1235 Fifteenth Street Augusta, GA 30901-3182 Fax: 706-822-8691 2024-2025 AUTHORIZATION FOR RELEASE OF STUDENT RECORD INFORMATION The financial information on your student account is confidential and protected by the Family Educational Rights and Privacy Act (FERPA) of 1974, as amended. FERPA is also known as the Buckley Amendment, Statute 20 U.S.C. 1232(g), regulations 34 CFR Part 99. С cannot disclose personally identifiable information to a third party; this includes your parents, spouse, sponsor, etc. without your written authorization. This form will permit the Financial Aid Office to release specific information (financial aid awards, application data, disbursements, eligibility, and/or financial aid satisfactory academic progress status) about you to the person(s) you designate. PLEASE PRINT OR TYPE: _______________________________________ ____________________________ Student Name Student Social Security Number I authorize the С Financial Aid Office to release information to the following (do not list yourself): ________________________________________________________________________________________ Last Name First Name Middle _______/___________________________________________________________________________________________________________________ Month/Year of Birth Last 4-digits of SSN Relationship to Student __________________________________________________________________________________________________ Last Name First Name Middle ______/___________________________________________________________________________________________ Month/Year of Birth Last 4-digits of SSN Relationship to Student __________________________________________________________________________________________________ Last Name First Name Middle _______/___________________________________________________________________________________________________________________ Month/Year of Birth Last 4-digits of SSN Relationship to Student * To confirm the identity of the above person(s) authorized to receive the student financial information, С employees will not release information if the month/year of birth and the last 4-digits of the SSN is not provided. I understand that this authorization will remain in effect from the date the Financial Aid Office notes receipt of this form until the last day of Summer Semester 2017, unless I provide the Financial Aid Office with a written cancellation notice. __________________________________________________ _____________________________________ Student Signature Date ]_`ft   u   R T ھھڶwiwiwhB{hnk56OJQJhB{hnkOJQJ hB{h;'56OJQJ\]hB{h;'OJQJ h;'CJh;'CJOJQJh|OJQJh;'OJQJhCJOJQJ^JaJhzDCJOJQJ^JaJh;'CJOJQJ^JaJh;'CJOJQJaJh;'CJOJQJaJ#t  ( \ ] ^ ,  & Fh^hgdnk$a$$a$ 0^`0 &dP ( 4 = \ ] ^ + , O [ ` b c ɅɁ}wii^i^i^iRiRh:]h;'5OJQJh:]5CJOJQJh:]h;'5CJOJQJ h;'CJhBeh;'h:]h;'5>*\ h;'5CJOJQJ\^JaJh;'5OJQJ\^JaJ h5CJOJQJ\^JaJh;'OJQJ h;'5\h:]5CJ\h5CJ\h;'5CJ\ hnk5\hB{h;'5OJQJ\ , O [  !_`abr $^a$gd:] & F $h^ha$gd:]^h^h hh^h`h !y_`abeqrǼǼǼǶn!h:]h;'6CJOJQJ\]h:]h;'CJOJQJ\]h:]hwCJOJQJ\]!h:]hw6CJOJQJ\] hnkCJ h;'CJh:]5CJOJQJh:]h;'5CJOJQJh:]h;'5OJQJh:]h5OJQJh:]5OJQJhnk5OJQJ(PQR˿h;'CJOJQJ^Jh;'5CJOJQJ\^Jh;'CJOJQJ^J h;'5\h-I5CJ\hhd5CJ\h;'5CJ\ h;'CJh:]h;'CJOJQJ$a$^z+p,p-p.p1h/R 4567:p,/:/ =!"#h$% x2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List H@H  Balloon TextCJOJQJ^JaJDB@D Body Text$a$CJOJQJ^JPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V (BO)MBT.$@0H!A>풠Uc-zD[&!rX=}zC0` ި%.]Ssd--7 +fOZեrŵVœ\lji2ZGwm-3˵j7\ Uk5FҨ-:xRkcr3Ϣ+9kji9OP Et-j|#p;E=Ɖ5Z2sgF=8 K}*7c<`*HJTcB<{Jc]\ Ҡk=ti"MGfIw&9ql> $>HmPd{(6%z:"'/f7w0qBcF6f Iöi1(\}B5ҹ~Bcr6I;}mY/lIz1!) ac 1fm ƪN^I77yrJ'd$s<{uC>== Ƌ(uX=WA NC2>GK<(C,ݖm: &-8j^N܀ݑ$4:/x vTu>*ٞn{M.Ǿ0v4<1>&ⶏVn.B>1CḑOk!#;Ҍ}$pQ˙y')fY?u \$/1d8*ZI$G#d\,{uk<$:lWV j^ZơSc*+ESa1똀 k3Ģxzjv3,jZU3@jWu;z \v5i?{8&==ϘNX1?  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