Office of the Registrar
DuBourg Hall, Room 22
One Grand Boulevard
Saint Louis, MO 63103
Phone: (314) 977 2269
Fax: (314) 977 3447
Request to Prevent Disclosure
of Directory Information
Print Clearly or Enter Fields Electronically to Ensure Accurate Entry
Student Name (Printed): Student ID #: _ _ _ _ _ _ _ _ _
Student Signature:
Date: _ _ / _ _ / _ _ _ _
To All Saint Louis University Students
The Family Educational Rights and Privacy Act of 1974 (FERPA) in general provides that
personally identifiable information from a student’s record cannot be released with the
consent of the students. One of the exceptions under the Act is information that the
University has designated as “Directory Information,” if the University has given public notice
to students in attendance of:
1. The types of personally identifiable information that the University has designated as
directory information;
2. A student’s right to refuse to let the University designate any or all of those types of
information about the student as directory information; and
3. The period of time within which a student has to notify the University in writing that he or
she does not want any or all of those types of information about the student designates
as directory information.
Saint Louis University has designated the items below as directory information:
Name, home and school address, home and school telephone numbers, E-mail address,
major and field of study, participation in officially recognized activities and sports, weight
and height of members of athletic teams, dates of attendance, degrees and awards
received (including Dean’s List), and the most recent previous educational institution
attended.
You have the right to refuse to let the University designate the above types of information
about you as directory information by filling out the form below at any time while you are a
student and returning it to the Office of the University Registrar, DuBourg Hall, Room 22,
1 Grand Boulevard, Saint Louis Missouri 63103.
Restrict Directory Information
This will prohibit publication of above information from University phone
book, people finder, and news releases
Release Restriction of Directory Information
Month / Day / Year
