OFFICE OF STUDENT FINANCIAL AID
PERMISSION TO RELEASE STUDENT RECORD INFORMATION
The Office of Student Financial Aid will release most information from the student’s record to the
person identified below as an authorized representative. We will not automatically disclose
information about the student’s academic progress status without an additional statement from the
student authorizing this disclosure; nor will we permit the authorized representative to pick up
financial aid documents (award letters, etc.) from our office, unless the student makes an additional
request to this effect on this permission slip.
Permission slips are valid for one financial aid year (Summer through Spring Quarter). The student
may cancel the permission at any time by submitting an additional written statement requesting
cancellation.
Student’s
Name:__________________________________________________________________________
Social Security Number______________________ UW Student Number_____________________
This request is (check one only): ______2008-09 ______2009-10 ______2010-11
I give the University of Washington Office of Student Financial Aid permission to discuss my financial
aid application status, award or eligibility with the following individual(s). I understand that this
permission will remain in force from the date the Office notes receipt of this form until the last day of
Spring Quarter of the above noted year, unless I provide the Office of Student Financial Aid with a
written cancellation notice.
Representative’s Name
Relationship to Student:
Representative’s ID Number
(Social Security or driver’s license number)
Additional Request:
Student’s Signature:
Date:
105 Schmitz Hall, Box 355880 Seattle, WA 98195-5880 phone: (206) 543-6101 fax: (206) 685-1338
Office Hours: Monday –Friday 9:00 am – 5:00 pm
Email: osfa@u.washington.edu
I:osfa/counselors/forms/release of information form.doc Feb 2009