Restrict Student Directory Information Request Form

Restrict Student Directory Information Request Form
Completed form will be submitted digitally to the Registrar's Office for processing. Effective date of this request is the day it is processed.
Name

First NameMiddle InitialLast Name
In accordance with the provisions of the Family Educational Rights and Privacy Act of 1974 (FERPA), I request that the Office of the Registrar restrict all Student Directory Information. With this request, such information is treated as confidential; and, in response to public inquiries, the University will verify only whether I am currently enrolled. I understand that this request remains in effect until such time as I specifically authorize the release of that information by completing a REVOKE RESTRICTION OF STUDENT DIRECTORY INFORMATION REQUEST.
Student's Signature

Clear
Date

MonthDayYear
Date
Should be Empty: