Financial Information Release

DO NOT COMPLETE THIS FORM FOR YOURSELF

The purpose of this release is to facilitate the communication of student information to authorized individuals identified by the student.

The Family Educational Rights and Privacy Act of 1974, as amended, protects the privacy of education records, establishes the rights of students to inspect and review their education records, and provides guidelines for the correction of inaccurate or misleading data through informal and formal hearings.

This release applies to all financial information pertaining to your WLU Student Account.

The student choosing to release his or her rights must complete and sign this form before WLU releases information to the individual listed below. If you would like for a parent/guardian to be able to receive your student invoices/statements or make financial arrangements on your behalf please list their name below.
Student Information:
Name of the Student*
Student's West Liberty Email Address:*

Please enter ONLY a Westliberty.edu address
Student ID Number*
Last 4 digits of Student's Social Security Number*
Recipients Information:
I authorize West Liberty University to release my financial records to the person specified below:
Name:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email of Authorized Party*
Relationship to Student
The above information may be released with my full consent. I understand that this authorization remains in effect until my written revocation is confirmed and received by the WLU Business Office.
Electronically sign with your initials below:*
Phone
This field is for validation purposes and should be left unchanged.

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Financial Information Release

Financial Information Release

Student Information:

Recipients Information:

BUSINESS OFFICE

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