Authorization to Release Information Form

In accordance with regulations contained within the Family Educational Rights and Privacy Act, Empire State College will disclose to designated parties information from the educational records of a student, provided the college has on file a written request.

Authorization to Release Information Form (PDF  46kB)

(You will need Adobe Acrobat Reader to use this file. If you are unable to open this file, please contact us at Registrar'sOffice@esc.edu for assistance.)

Please complete the form and affix your signature to indicate your consent to release your educational records to such parties you designate. Active students must submit this form to the Office of the Registrar by:

U.S. MAIL
Office of the Registrar
Empire State College
2 Union Avenue
Saratoga Springs, NY 12866.

Or

FAX
518 580-0105