FORM - SHORT MODE

FERPA - Release & Opt Out | In
In accordance with the Family Educational Rights and Privacy Act (FERPA), UWest does not disclose your educational records without your written or digital consent, except as permitted or required under FERPA regulations. Please note that your parents and guardians are not authorized to access your record without your consent.

Non-directory information refers to all personally identifiable educational records created while a student is enrolled at UWest, except for designated directory information. Examples of non-directory information include transcripts, schedules, grade point average, courses completed, and grades earned, attendance, advising records, loan, and payment information.

Directory information is strictly defined and includes only name, UWest email, major, honors, degrees, and graduation information. Directory information may be released unless you formally opt out of such release.

The university does not release student information of any sort, including directory information, to mailing lists. See the University's FERPA policy, found on the university's website, for details.

Submit this form to allow the release of your non-directory educational records to a designated individual or institution, or to initiate or cancel Opt-Out status regarding the release of directory information.
DATE SUBMITTED*

MonthDayYear
Date
NAME*

First NameLast Name
STUDENT ID*
PHONE*
EMAIL*
example@example.com
CURRENT ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
TYPE OF REQUEST*

AUTHORIZE RELEASE OF RECORDS (non-directory information)DIRECTORY INFORMATION OPT OUT or IN
RELEASE*

All RecordsDesignated Records Only
CHECK ALL THAT MAY BE RELEASED If other is selected, please provide specific details*

AttendanceFinancialGradesScheduleStatusOther
DURATION OF RELEASE*

Release in Effect Until Revoked in WritingTemporary Release
EXPIRATION DATE*

MonthDayYear
Enter date release expires
HOW DOES THIS REQUEST AFFECT PRIOR RELEASES*

Replaces Prior Release(s)Additional Release, prior release(s) remain in effect
I authorize University of the West to release my educational records indicated above to the individual(s), agencies, or institutions designated here.
RECIPIENT*
Full name of designated individual, agency, or Institution
RELATIONSHIP*
E.g. parent, employer, mentor, home college, etc.
ADD ANOTHER RECIPIENT?*

NOYES
RECIPIENT*
Full Name or Institution
RELATIONSHIP*
E.g. parent, employer, mentor, etc.
ADD ANOTHER RECIPIENT?*

NOYES
RECIPIENT*
Full Name or Institution
RELATIONSHIP*
E.g. parent, employer, mentor, etc.
Directory information is general information such as Dean's and President's lists, Commencement programs, email rosters, etc. This informaton may be released without your consent or knowledge, except when you submit this form to notify the university that you wish to formally opt out of such release.

The block on directory information is effective the date this form is received by the Registrar's Office.

Directory information includes the following records only:
- Name
- UWest Email Address
- Major Field of Study
- Honors or Awards Earned and Dates Awarded
- Degrees Awarded and Date Conferred
- Graduation Photograph
If you choose to opt out, you understand that you may not be included on any earned honor's list or in the commencement program.
REQUEST*

OPT OUTOPT IN (use to reverse prior Opt Out)
OPT OUT*

FULL - release no directory informationPARTIAL
If you choose to fully opt out, you understand that your name will not appear on any earned honor's list or in the commencement program.
CHECK ALL THAT APPLY*

NAMEEMAILMAJORHONORS/AWARDSGRADUATION (degrees, dates, photo)
By selecting Opt In, you are cancelling any previous restriction and are approving the release of your directory information, defined above. No non-directory records will be released without your express approval.
By signing, I verify that I am the student of record. I understand that the instructions I have indicated on this form are effective the date the form is received by the Registrar's Office and these instructions will remain in effect until I submit a formal change request.
Signature*

Clear
REGISTRAR'S OFFICE

Date Processed: Processed By:

Comments:
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FERPA - Release & Opt Out | In