FERPA RELEASE FORM for REVERSE TRANSFER
The Family Educational Rights and Privacy Act (FERPA) is a federal law that gives students various rights with respect to their educational records. Under FERPA you have the right to inspect and review your educational records, the right to request amendment of records you believe are inaccurate or misleading, and the right to prevent disclosure of information from your educational records without your prior consent, subject to some specific exceptions.
If you currently have at least 66 credits and meet the other eligibility criteria spelled out in the NJ Statewide Reverse Transfer Agreement and wish to authorize Rutgers University to send your academic records to your former community college for consideration for award of an Associate degree, please complete this form and submit it to Les Cole, Associate University Registrar, at universityreg@registrar.rutgers.edu.
Student Name: ________________________________________________________
RUID: ______________________________________________________________
Date of Birth: _________________________________________________________
Email Address: ________________________________________________________
Community College: ____________________________________________________
(Note: If you have attended multiple community colleges, please cite the most recent.)
___________________________________________ _____________________
(Signature) (Date)
NOTARY PUBLIC (Only necessary if this form is not being signed in the presence of Rutgers University Staff):
State of ______________________________________, County of ___________________________________
The foregoing release form was acknowledged before me by ____________________________________________,
this ____________________________ day of _____________________, ________________.
Witness my hand and official seal: ________________________________________________________
My commission expires on: ______________________________________________________________
For mailing:
Les Cole
Associate University Registrar
65 Davidson Rd., UES – Office of the Registrar, Room 304
Piscataway, NJ 08854
(848) 445-2620