In fulfillment of the University’s obligation under the Family Educational Rights and Privacy Act, notice is hereby given to students of the
University’s FERPA policy and students’ rights under the act. 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 institutions that receive funds
under an applicable program of the U.S. Department of Education. FERPA was designated to protect the privacy of educational records, to
establish the rights of students to inspect and review their educational records, and to provide guidelines for the correction of inaccurate or
misleading data through informal and formal hearings. Students also have the right to file a complaint concerning any alleged failure of the
University to comply with the act. Complaints may be addressed to:
Family Policy Compliance Office,
US Department of Education
400 Maryland Avenue, SW
Washington, DC 20202-5901
FERPA identifies certain data as “directory information,” which may be freely released to the public without written authorization of the
student. Students may file a form with the Registrar’s Office requesting withholding of directory information. The student’s records will be
kept confidential until the student requests in writing that the confidentiality hold be removed. CSU Channel Islands designates the following
items as directory information:
Directory Information:
Student’s name
Address (local and permanent)
University assigned e-mail address
Major field of study
Dates of attendance
Full-time or part-time status
Degrees, awards, and honors received
Dates degrees conferred
For Student Employees
Department where employed
Employee Status (i.e. Graduate Assistant, Instructional Student Assistant, Teaching Associate)
CSU Channel Islands FERPA website:
Request to Withhold Directory Information
Under the provisions of the Family Educational Rights and Privacy Act of 1974 you have the right to withhold disclosure of directory
information. California State University Channel Islands will honor your request to withhold directory information until such time as you
inform the University in writing that you withdraw the request.
Please consider carefully the consequences of any decision to withhold directory information. Once such a request has been filed, the
University will not respond to any requests for information about you and your name will not appear on any official rosters for events such
as Honors Convocation or Commencement, for example. Additionally, the University will not respond to request for verification of
enrollment or of degree conferred without your written authorization.
*Submit this form in person to the Registrars Office located in the Enrollment Center, Sage Hall.
I hereby request that CSU Channel Islands withhold directory information from public disclosure until I withdraw this request. I
have read the above information and understand the consequences of my request.
_____________________________________________ __________________ ____________________________________
Student Name Student ID E-mail
_________________________ ______________________________________________________ _____________________
Phone Signature Date
Administration Use Only-Registrar’s Office
Processed by: _________(Staff Initials) PS Update: _________ (Date) Revised 4/3/19
Enrollment Management
The Registrar’s Office
One University Drive
Camarillo, CA 93012
Phone: (805) 437-8500
Telephone number (local and permanent)
Student photo
Expected date of graduation
Previous schools attended
Enrollment status (class level)
Currently enrolled (Y/N)
Participation in officially recognized activities and