AUTHORIZATION FOR RELEASE OF
The Family Educational Rights and Privacy Act of 1974 (FERPA) allows the Institute to release information from a student’s educational
record without the student's written consent to school officials who have a legitimate educational interest in the record, or to a parent if the
student is a dependent of that parent as defined by the Internal Revenue Code. The Institute will not release student records to any
other outside parties unless permission is specifically indicated by the student on this Authorization for Release of Student
Information Form which must be completed and signed by the student at the time of registration. This form must be updated
each year. All changes must be made at the Office of the Registrar.
By providing the information below, you agree to authorize individual offices under the Divisions of Student Affairs and Business Affairs
(see below for list of offices) at The Cleveland Institute of Art to release your student information - including grades, academic standing,
enrollment, attendance, financial standing, or results of disciplinary proceedings only to the persons or agencies you have listed.
□ Check this box if you are claimed as a dependent on your parent’s most recent tax return.
Mother’s Name (please print): _____________________________ Father’s name (please print):
Please PRINT the following information for each person or agency who may request/receive information on your behalf.
Name of person or agency: Relationship to Student:
Check this box if you DO NOT authorize The Cleveland Institute of Art to release your student information to anyone.
STUDENT AFFAIRS OFFICES
Academic Services, Admissions, Financial Aid, Registrar, Student Life
Student Name & Housing, Dean of Admissions and Student Affairs
BUSINESS AFFAIRS OFFICES
CIA USE ONLY
Student ID or Social Security Number Date Date Received: _______________
Tracked by: _________________