Authorization to Release Information

Student Name

BYUH ID#

This is a 7-digit number (for example, 1234567).

Current Street Address

Please specify a Hawaii address; if you do not know what your Hawaii address is, simply use the default mailing address for the campus (55-220 Kulanui Street, Laie, HI 96762)

City

State

HI

Zip Code

Phone Number

Email Address

Certification

By submitting this form, I give Brigham Young University–Hawaii permission to discuss with the person(s) below the information as described by that above-mentioned student.

Name (Contact 1)

Relationship (Contact 1)

Name (Contact 2)

Relationship (Contact 2)

Authorized circumstance(s) to disclose to above named person(s).

Please specify which area of your financial information we can disclose; if our office can discuss all information pertaining to your student account, simply write, "Everything pertaining to my financial aid".

This is so that we know what information you allow us to disclose and to whom.

Please complete the captcha before submitting

Authorization to Release Information - FERPA Waiver

State

Certification