HERE2ODU (ODU Mobility Pass) Opt-in and Release Form

Name*

First

Middle

Last

Date of Birth*

ODU Student ID Number (optional)

Have you received correspondence from ODU about this program*

If you have already applied to TCC, please provide your Student ID Number

Enter Mailing Address Below*

Street Address

City

State

ZIP Code

Email*

Phone Number*

FERPA Statement

The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C.& 1232g: 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. In accordance with FERPA, it is the policy of TCC amd ODU to withhold certain educational records unless the student provides consent to disclose information. The purpose of this form is to provide the consent to TCC and ODU required by FERPA.

I, the undersigned, hereby understand and authorize TCC and ODU to release/discuss educational records and information and agree to my student records being shared between the two institutions for the purpose of credit evaluation to award any degree, diploma, or certificate, if I am eligible to graduate.

This release does not permit the disclosure of these records to any other persons or entities without my written consent or as permitted by law. This release form is effective from the date of submission and consent remains in effect until receipt of written revocation.

Response Required:*

I accept

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