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STUDENT REQUEST FOR RELEASE OF FINANCIAL AID INFORMATION <br /> University of Wisconsin — Madison Office of Student Financial Aid <br /> This form is intended for student use to authorize release of private student record information to a third party. Prior to <br /> submitting this form, please check to see if you can provide the information to a third party yourself, through access to <br /> your record at the Student Center in My UW(my.wisc.edu or myinfo.wisc.edu). For additional information about privacy of <br /> student information, please visit registrar.wisc.edu/FERPA. Please fill in all information below and sign. <br /> Student ID# Date of Birth(mm/dd/yyyy) <br /> 9084088674 04/12/04 <br /> Last Name First Name Middle Maiden/Previous Name <br /> Uontop Isabella Uontop <br /> Email Address and/or Phone Number <br /> izryllontopl2@gmait.00m(608)800-2612 <br /> 1) I give the Office of Student Financial Aid at the University of Wisconsin-Madison permission to release the <br /> following private/protected information(check all that apply): <br /> I My financial aid award detail I My private loan requests <br /> III My federal loan requests I My eligibility for aid <br /> ❑ Other(please specify): <br /> 2) This request to release information is pursuant to the following purpose(check all that apply): <br /> Pi Tuition payment I Future financial planning <br /> I Housing payment <br /> ❑ Other(please specify): <br /> 3) I authorize you to release the information above to the following third-party(indicate relationship): <br /> Margaret S Llontop(mother) <br /> 4) Preferred method of delivery to person/organization named in 3)above: <br /> ❑ Phone(specify number with area code): (608)333-5770 <br /> ❑ Email(specify email address): peggythepooh @gmail.com <br /> ❑ U.S. mail(specify mailing address) 214 Howard St, Marshall,WI <br /> My required signature below indicates that I have read and understand the following: <br /> • I understand that this request is applied indefinitely until I choose to revoke it. If there is a hold on my record which prohibits <br /> release of information,this request wilt not be fulfilled. <br /> • I understand that it is my responsibility to check for and clear any holds that prohibit release of information prior to submitting this <br /> request. Holds can be checked through the My UW portal at my.wisc.edu or myinfo.wisc.edu. <br /> • Requests will be reviewed and processed by the Office of Student Financial Aid within five business days of receipt,and will not be <br /> valid fbr future retluests <br /> • I understand that I must complete a separate release form for each request. <br /> • I understand that I will not be contacted when the above information is released to the designated recipient. <br /> • This form is valid only for requesting the release of financial aid information maintained by the Office of Student Financial Aid. It <br /> is not intended for release of academic,health or other student records that reside on campus in deans offices,academic <br /> departments,etc. <br /> • I understand that both myself and my third-party must comply with the two part authentication process by providing my campus ID <br /> and one of the following(date of birth,wisc.edu email,or last four digits of SSN) <br /> Signature ,s 1/34A.50.1.84.- Date 03/18/22 <br /> Printed Name Isabella Llontop <br /> Submit this form in person, by mail, or email to: University of Wisconsin-Madison Office of Student Financial Aid, 333 <br /> E Campus Mall#9701, Madison, WI 5371 5-1384 <br />