Consent Form for Disclosure to Parents/Guardians, Financial Sponsors, and Agents

To: Registrar, University of Massachusetts
      Managing Director, University of Massachusetts, Boston International Direct

Student Information

Date of Birth

Please read the following statement regarding the disclosure of personally identifiable information from your education record. If you agree with the statement, please click “I consent” below. If you do not agree with the statement, please click “I do not consent” below.
I consent to the disclosure of any personally identifiable information from my education records to the individual(s)/organizations(s) named below, for reasons determined by the University of Massachusetts, Boston and University of Massachusetts, Boston International Direct as appropriate. I understand that the purpose of the disclosure is to inform the parties listed below of my progress and status at the University of Massachusetts, Boston, as well as any circumstances affecting my attendance at the University of Massachusetts, Boston. I understand that my education records may be disclosed to my Parent(s)/Guardian(s) through my Agent/Education Counselor and that my Agent/Education Counselor may only re-disclose education records to my Parent(s)/Guardian(s) identified below. This authorization will remain in effect for the duration of my tenure at the University of Massachusetts, Boston, but I may revoke the consent by written notice at any time.*


Financial Sponsor

Agent/Education Counselor

To complete the FERPA submission process, follow these steps:
  1. Click the "Submit" button below. 
  2. Review your information on the form that opens.
  3. Add your e-signature and click the "Submit Signed Response" button. 
  4. Once you have submitted your e-signature, a verification email will be sent to you. Click the link in the email you receive to complete the submission process. 

*Students cannot be denied any educational services from the University of Massachusetts, Boston if they refuse to provide consent.