Release of Deceased Student Records Operating Procedure

Release of Deceased Student Records Operating Procedure

Operating Procedure Section: IT, Security, Privacy & Records

Procedure Number: 3.045

Effective Date: 12/04/10

Arkansas State University System regards academic records of deceased students as confidential information. Records of a deceased student will be made available to the executor of the estate, parent, spouse, child or next of kin upon written request, or as required by court order or lawfully issued subpoena. The written request must identify the requestor’s relationship to the deceased student and must include a copy of the death certificate. The Registrar reserves the right to refuse any request for records which does not comply with the above requirements.

Example form:

Request for Deceased Student Records

Please complete the following form, attach a copy of the death certificate, and return the form and the death certificate to the Office of the Registrar,            _________________(Address)__________________________.

Requestor Name (Printed): ___________________________________________________________________

Address: __________________________________________________________________________

Telephone Numbers: _______________________________________________________________

Relationship to Deceased Student: __________________________________________________

Name of Deceased Student: ________________________________________________________

Date of Birth of Deceased Student: __________________________

Dates of Attendance: _______________________________________________________________

Social Security or Student Identification Number:______________________________________

I certify that the above information is true and correct to the best of my knowledge and belief

Signature of Requestor: ___________________________________________________________

Date: _____________________________________________________________________________

A copy of the death certificate of the deceased student is required to be attached to this form.