This consent will begin the date of this authorization and will expire one year from submission unless revoked by me in the interim. I, the undersigned, hereby acknowledge that I have read this authorization prior to its execution and fully understand the nature of this release. All information released will be handled confidentially in compliance with the Federal Privacy Act (PL 93-380 Sec. 438) and the Pennsylvania Mental Health Procedures Act, and the Federal Educational Rights Privacy Act or FERPA.
FERPA