Fillable Amridge University Ferpa Directory Information Opt Out Form printable pdf download

OFFICE OF THE REGISTRAR

1200 Taylor Road

Montgomery, AL 36109

334.387.7528

AMRIDGE UNIVERSITY FERPA DIRECTORY INFORMATION OPT-OUT FORM

Name (Printed)

Student ID: ____________________________________

NOTICE OF DIRECTORY INFORMATION

In accordance with Federal Educa onal Rights and Privacy Act of 1974

(FERPA), as amended, a student’s education records are maintained as conﬁdential

by Amridge University and, except for a limited number of special circumstances listed in that law, will not be released to a third party without the student's

prior wri en consent. The law, however, does allow Amridge University to release student "directory informa on" without obtaining the prior consent of

the student. At Amridge University we consider "directory informa on" to be those items of informa on listed below in this Form. If you do not want

Amridge University to release your directory informa on without your prior consent, you may choose to "opt-out" of this FERPA excep on by signing the

Form below. This form must be received in the Registrar's Oﬃce on or before the tenth class day of the fall and spring semesters, or the

ﬁfth class day in the

summer term in order for it to be applicable to that semester/term and for subsequent periods of me. Directory informa on of a student who has opted-

out from the release of directory informa on, in accordance with this policy/procedure for op ng-out, will remain

ﬂagged until the student requests that

the ﬂag be removed by completing and submitting the revocation section of this form to the Amridge University Registrar

Some of the eﬀects of your decision to request conﬁdential status will be that you must make all address changes with a signed authorization or in person

with a form of ID; friends or relatives trying to reach you will not be able to do so through the University; information that you are a student here will be

suppressed, so that if a loan company, perspective employer, family member, etc., inquire about you, they will be informed that we have no record of your

attendance here. Once you have designated a conﬁdential classiﬁcation, it will not be removed until you submit a signed authorization requesting that it be

removed.

TO:

Amridge University Registrar

I request the withholding of the following personally-identiﬁable information that Amridge University has identiﬁed as Directory Information under

FERPA. I understand that upon submission of this form, the information checked cannot be released to third parties without my written consent or

unless Amridge University is required by law or permitted under FERPA to release such information without my prior written consent; and that the

checked directory information will not otherwise be released from the time the Registrar receives my form until my opt-out request is rescinded. I

further understand that if directory information is released prior to the Registrar receiving my opt-out request, Amridge University may not be able to

stop the disclosure of my directory information.

□ ALL INFORMATION INDENTIFIED BELOW

CHECK ALL BOXES THAT APPLY

□ Name

□ Dates of Enrollment

□ Local and Permanent address

□ Degree(s) earned, including date, honors and level of dis nc on

□ Telephone Number(s)

□

Major ﬁeld of study

□ Par cipa on in oﬃcially recognized ac vi es

□ Academic level