International and Multicultural Programs

Authorization for release of

International Student Information

The United States of America places a high value on the privacy of an individual’s personal
information. The purpose of the Family Educational Rights and Privacy Act of 1974 (FERPA)
is to protect the privacy of information concerning individual students by placing certain
restrictions on the disclosure of information in your application file. Beyond the protection
required by law, Barry University will normally not release information from your
international student file to anyone except you, without your expressed written permission.

If you wish us to release information from your application file to anyone, you must provide
us with your written consent clearly specifying that we may release this information. You
must specify which information may be released and exactly to whom the information may
be released.

By authorizing Barry University to release this information, you are waiving the FERPA rights
normally associated with this information from your international student file.

Please indicate below which information we may release and to

whom we may release this information.
Please initial in the space next to any information we may release:
Any Application Status Status of I-20

List of missing documents SEVIS number

List of received documents Information relative to financial

documents (for I-20 purposes)

Any information initialed may be released to:

1.
2.
3.
4.
5.
6.

 Initial below ONLY if you do not want your personal information

released to anyone who normally would not have the right to have
this information.
Do not release any of my personal information to anyone.

I understand that this consent or non-consent shall remain in effect until revoked by me in
writing.

Applicant Name

Applicant Address
Applicant Signature Date

*All fields must be completed.