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By completing this document, students explicitly authorize designated individuals to receive information pertaining to their enrollment period. The form outlines necessary security protocols, requiring authorized parties to verify specific personal data, including the student's ID number, date of birth, and the designated individual's own sensitive information, such as the last four digits of their Social Security number and date of birth, ensuring strict compliance with the Privacy Act of 1974. This document remains valid throughout the student's enrollment unless formally updated or modified by the student, providing a secure and flexible framework for managing access to sensitive personal information while maintaining regulatory standards.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/authorization-to-release-information-student-financial-services/286849/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/authorization-to-release-information-student-financial-services/286849.png","ImageObject",442,249,{"name":88,"@type":89},"Marry","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-22","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":9},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of this form?","Question",{"text":108,"@type":109},"This form authorizes the Office of Student Financial Services to release a student's financial aid and academic records to specifically designated individuals.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What information must authorized individuals provide to access records?",{"text":113,"@type":109},"Designated individuals must verify the student's ID number and date of birth, and provide their own date of birth along with the last four digits of their Social Security number.",{"name":115,"@type":106,"acceptedAnswer":116},"Does this form need to be renewed annually?",{"text":117,"@type":109},"No, the form does not need to be renewed unless the student makes a change to the list of authorized individuals or wishes to update their permissions.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},286849,1790040744,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":9,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":4},5909892079670,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","STUDENT FINANCIAL SERVICES 1900 West Olney Avenue Philadelphia, PA 19141-1199  \nPhone: 215.951.1070  \n[www.lasalle.edu](www.lasalle.edu) [sfs@lasalle.edu](sfs@lasalle.edu)  \nAUTHORIZATION TO RELEASE INFORMATION  \nSTUDENT’S NAME:   STUDENT ID\\#:    \nCELL PHONE \\#:    \nPursuant to the provisions of the Privacy Act of 1974 (5 USC 552a, PL 93-579, as amended), I hereby authorize the Office of Student Financial Services to release information from my financial aid file and any other record (s) pertaining to me to the individual(s) listed below. I understand and agree that the information released will cover my time of enrollment and that the released information may be electronically transferred by the Office of Student Financial Services or its agents. I understand that before any information is released to the individual(s) I have designated below, they must verify my student ID number and date ofbirth, as well as provide the last four digits of their Social Security number and their date ofbirth.  \nNAME:   \nRELATIONSHIP:  SOCIAL SECURITY \\#:_XXX-XX-    \nADDRESS:  \n_________________________________________________________________  \n_________________________________________________________________  \nTELEPHONE\\#:   (HOME) TELEPHONE\\#:   (CELL) ALT. TELEPHONE\\#:   EMAIL ADDRESS:    \nNAME:  RELATIONSHIP:  SOCIAL SECURITY \\#:_XXX-XX-   \nADDRESS:  \n_________________________________________________________________  \n_________________________________________________________________  \nTELEPHONE\\#:   (HOME) TELEPHONE\\#:   (CELL) ALT. TELEPHONE\\#:   EMAIL ADDRESS:    \nDO NOT FORGET TO SIGN THIS DOCUMENT  \nStudent’s Signature:  Date:   \nThe Authorization to Release Information form is required for all students and may be updated at any time during your enrollment. This form does not need to be renewed unless you make a change to the individual(s)  \nwith whom we are authorized to share information.","cbCaib93CmQx0WYe","https://ap.wps.com/l/cbCaib93CmQx0WYe","pdf",338084,"English","# Authorization to Release Information\n## Student and Designated Individual Details\n## Terms and Conditions of Release\n## Signature and Submission","[{\"question\":\"What is the purpose of this form?\",\"answer\":\"This form authorizes the Office of Student Financial Services to release a student's financial aid and academic records to specifically designated individuals.\"},{\"question\":\"What information must authorized individuals provide to access records?\",\"answer\":\"Designated individuals must verify the student's ID number and date of birth, and provide their own date of birth along with the last four digits of their Social Security number.\"},{\"question\":\"Does this form need to be renewed annually?\",\"answer\":\"No, the form does not need to be renewed unless the student makes a change to the list of authorized individuals or wishes to update their permissions.\"}]","Authorization to Release Information - Student Financial Services | PDF",1789631616]