Financial Information Release

Form to be completed by West Liberty University Student Only.

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

Students at West Liberty University benefit from the provisions of the Family Educational Rights and Privacy Act of 1974. Students, under this Act, have the right to have their educational and financial records protected from release. However, a student, by written consent, can request an individual recipient(s) to have permission to discuss their financial records with college officials. By completing and submitting the form below, the student gives WLU’s Business and Financial Aid Offices permission to discuss financial records with the listed individual recipient(s). Financial records include student account information and limited financial aid information allowed by federal regulations. West Liberty assumes no responsibility, or liability, caused by releasing any information to the individual recipient(s) named on the form. The student must provide a written request to the Business Office and the Financial Aid Office at WLU in the event they no longer want to permit their financial records to be discussed with the listed individual recipient(s).
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*
Recipient(s) Information:
I authorize West Liberty University to release my financial records to the person(s) specified below:
Full Name:*
Email of Authorized Party*
Relationship to Student*
Additional Recipient Information (Optional):
Full Name:
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 and Financial Aid Offices.
Electronically sign with your initials below:*
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Financial Information Release

Financial Information Release

Student Information:

Recipient(s) Information:

Additional Recipient Information (Optional):

BUSINESS OFFICE

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