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FERPA Form Southern Alabama AHEC

 
 

In order to fulfill the conditions of their grant, Southern Alabama AHEC requests permission to certain educational records (as described below). Please complete this form indicating whether or not you agree to share this information with them.

I hereby authorize the University of South Alabama Center for Continuing Education and its employees to discuss with and/or release to Southern Alabama Area Health Education Center and its employees the education records identified below that pertain to me.

1) Records associated with the University of South Alabama Ed2go and continuing education course(s) sponsored by the Southern Alabama Area Health Education Center. This release covers

  • Progress Reports
  • Performance Data
  • Final Grades
The purpose of this disclosure is to inform the Southern Alabama Area Health Education Center of my performance record for the duration of the course/program and the final grade(s) to determine “compliance” with the terms and conditions of the funding and for their aggregate reporting to funders. I understand that this authorization must be completed by me and presented with each additional request for the release of education records and that I have the right to request a copy of the records released. I also understand that I have the right not to consent to the release of these records. I further understand that I have the right to revoke this authorization in writing and deliver it to the University of South Alabama Center for Continuing Education but that any such revocation will not affect disclosures made prior to its receipt by the University.