AUTHORIZATION TO RELEASE
FINANCIAL INFORMATION

The privacy of personal information of a student, 18 years of age or older, or a student under age 18 attending a post-secondary education institution, is protected under FERPA (Federal Family Educational Right to Privacy Act of 1974) and the State of California Education Code.  Without the express written permission of the student to disclose it, financial information is held in strict confidence and made available only to the student.

A student may wish to allow his financial information to be discussed with another individual, (a parent for example).  The student must name the individual(s) and the relationship between them, and personally sign and deliver the release information.  Campus Billing Services, the Central Cashier and Accounting will disclose financial information to the named individual(s) until this authorization is rescinded.

I hereby authorize Accounting and Fiscal Services to release my financial information to the following individual(s).  The information may include all debits (charges), credits (payments, waivers) or holds on my UCI accounts.

I understand that I can revoke this authorization for any or all of these named individual(s) at any time, in writing.

__________________________________________________	___________________________
Student Signature	Date
**Alternate ID (Social Security, Driver's License, or Date of Birth)	___________________________

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