College%20Chapter%20Roster%20&%20Student%20Records%20Release

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A L P H A P H I A L P H A F R AT E R N I T Y , I N C .

®

| 2313 ST. PAUL ST, BALTIMORE, MD 21218

Chapter Roster & Student Records Release

Federal Educational Rights and Privacy Act Notice: The Federal Educational Rights and Privacy Act (F.E.R.P.A.) govern the sharing of information from a student’s record. This Act establishes guidelines for releasing information pertaining to the educational records of students. The Act permits students to restrict access to their records. According to F.E.R.P.A., an academic institution must receive your written permission before your grades can be released to and reviewed by Alpha Phi Alpha Fraternity, Inc. (The Fraternity). Members and applicants for membership must comply with The Fraternity’s academic standards (Policies). The Fraternity collects and analyzes members’ scholastic achievements and grades. Your authorization allows the Fraternity to collect your personal grade point average (G.P.A.), compile it with data from your Chapter and other Chapters, and report the results to The Fraternity’s membership. Your personal information, such as your University ID# and name will not be released to the General Membership when the compiled data is reported to The Fraternity’s membership; it is kept confidential. I, herby authorize the release of my cumulative and semester grade point average, hours attempted and participation in organization activities to Alpha Phi Alpha Fraternity, Inc.

PLEASE PRINT LEGIBLY Name of University

City

Chapter Name

State

Chapter Key

Chapter President

Univ. Greek Life / Student Affairs Advisor Name: Univ. Greek Life / Student Affairs Phone: (

Zip

Title:

)

Alpha Alumni Chapter Advisor Name:

-

Email Grading Period: Fall [ ] Spring [ ] Yr. End [ ]

Note: Chapter Members should complete the Name, Position, University ID and Signature fields ONLY Greek Life or Student Affairs Personnel must complete the GPA information. Full Name

Position/Status

Univ. ID#

Signature

Sem. GPA (University Official)

Cum GPA (University Official)

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Chapter Cumulative

Univ. Greek Life / Student Affairs Officer :_____________________________________(Signature)____/____/_____(Date)

Phone: 1.800.373.3089 Email: Membership@apa1906.net

Page 1 of 1 tmpvJc56Q updated 08/11/2009


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