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STUDENT CONSENT TO RELEASE ACADEMIC INFORMATION
By signing below I understand that my grades will be released to Ruby Tuesday, Inc. for the purpose of the
Tuition Reimbursement Program.
Family Educational Rights and Privacy Act (FERPA)
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law
that protects the privacy of student education records. The law applies to all schools that receive funds under an
applicable program of the U.S. Department of Education. FERPA gives parents certain rights with respect to
their children’s education records. These rights transfer to the student when he or she reaches the age of 18 or
attends a school beyond the high school level. Students to whom the rights have transferred are “eligible
students.”
Understanding my privacy rights under FERPA, I consent to giving access to my midterm and final grades from
my education records to Ruby Tuesday, Inc. for the purposes of participating in the Ruby Tuesday, Inc. Tuition
Reimbursement Program.
I understand that this access will continue until I revoke this access in writing; or until I cease to be a student at
___________________________________________. I authorize the above institution to allow a representative
of Ruby Tuesday, Inc. Benefits Department access to a copy of my grades. This authorization does not permit
the third party to make any changes.
Student’s Name: _________________________________________
Current Mailing Address: __________________________________
City, State, Zip: __________________________________________
Daytime Phone Number: ___________________________________
Social Security #: _________________________________________
Student’s Signature: _______________________________________
Date: ___________________________________________________
Email address ___________________________________________
Any questions regarding this benefit should be directed to:
Ruby Tuesday
Benefits Department
333 East Broadway Avenue
Maryville, TN 37804
Email at benefitsadministration@rubytuesday.com
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