STUDENT CONSENT FOR RELEASE OF INFORMATION TO THIRD-PARTIES

The Family Educational Rights and Privacy Act (FERPA) protects the privacy of student education records by prohibiting their disclosure without the student’s written consent, except under limited circumstances. Students may choose to allow the release of their education records to specified third-parties by completing the confidentiality form.

This release is needed for letters of recommendation, college transfer reports, and for an adviser to speak directly to a parent about a student’s academic record. Each release only covers that specific circumstance, with a specific DUS representative, for a limited duration of time; there are no blanket releases.

Please note that all fields listed must be completed and that the student must sign and date this form. Please further note that while this form may authorize the Division of Undergraduate Studies (DUS) to release the student’s records, it does not obligate DUS to do so. This Consent for Release of Information is a one-time authorization specific to this request only. DUS reserves the right to review and respond to requests for release of education records on a case-by-case basis.

Dean’s Recommendation forms and College Transfer Reports are often required by other schools or Universities that you may be applying to attend. The forms usually say something like: “To be filled out by college dean or official.” Due to the size of our unit, the Dean’s Office delegates this responsibility to DUS advisers. If information about disciplinary records is requested, the student will fill out the online Student Conduct Release of Conduct Records form and request to have the data sent to their assigned academic adviser. Once all data is collected, the adviser will mail the form directly to the designated institution(s).

IMPORTANT NOTES:

- Do not use this process for study abroad forms that require course evaluation. See an adviser.

-  To ensure the most efficient processing of your forms, please follow all steps below.

1. Fully complete and sign the Confidentiality Form 
   • If you are applying to multiple schools, you only need to sign one copy of this form.
      
2. Provide stamped, addressed envelopes for each recommendation letter you are requesting.
   • This is critical for timely processing and ensuring the accuracy of the mailing address(es).
      
3. Any questions about the forms or process should be directed to:
   • Jeff Gugino (jpg4@psu.edu), Assistant Director of Operations, Division of Undergraduate Studies

DUS Confidentiality Form / Dean's Recommendation Form

Penn State Confidentiality Resources