Skip to main content

FERPA Waiver Cancellation

Cancellation of FERPA Waiver for Scholars Application

  • This form is for those who have previously submitted a FERPA Waiver for the IV-E Scholars Application and who wish to rescind (cancel) their waiver.

    FERPA (the Family Educational Rights and Privacy Act) is a federal law protecting the confidentiality of student records. To comply with FERPA, universities must have students’ written permission to release information from their records to any third parties, including parents, employers, or scholarship donors.

    By completing and signing this form, you give the School of Social Work at Boise State University (the “University”) the right to disclose certain information about you to the Idaho Department of Health and Welfare (IDHW) solely for the purpose of the IV-E Scholars Stipend.

    Please note that should you decline to allow the release of the following information, your application may not be considered for the award by IDHW.

    The following information may be released to IDHW :

    • A copy of your social security card;
    • A copy of your government issued picture identification;
    • A copy of your letter of acceptance into University’s Bachelor’s and/or Master’s of Social Work program(s);
    • A copy of your Scholars program application packet;
    • A copy of your letter of acceptance into the Scholars program;
    • Documentation of state and/or federal Title IV-E activities in which you are engaged;
    • Field Learning Agreement; and
    • Other similar documents and information reasonably requested by IDHW relating to your Stipend and the Scholars program.
  • By clicking either box below, I acknowledge and agree that I have read, understood and execute or rescind this FERPA Waiver for the Scholars Program with full knowledge of its legal significance and sign this FERPA Waiver for the Scholars Program freely and voluntarily on behalf of myself and/or my dependent, if my dependent is under eighteen (18). I further hereby consent to and authorize the use of electronic means to enter into, deliver, and evidence my consent to this FERPA Waiver and acknowledge that consistent with Idaho Code § 28-50-107 as amended from time to time, I understand and agree that the electronic signature will be legally binding.