This form may only be submitted in person at the One-Stop Services Center with a valid photo ID. Requests for alternate
submission methods must be submitted to and approved by the Office of the Registrar.
Updated 08/2013
Directory Information Non-Disclosure Form
Under the Family Educational Rights and Privacy Act of 1974 (FERPA), the following directory information
may be made public unless the student desires to withhold this information:
At its discretion, the University may release Directory Information, which shall include:
1. Name, address, telephone number
2. Major field of study at UT Tyler
3. Dates of attendance
4. Most recent previous educational institution attended
5. Classification (freshman, senior, etc.)
6. Degrees, certificates and awards received
7. Date of graduation
8. E-mail address
9. Photographs
10. Participation in officially recognized activities and sports
11. Weight and height of members of athletic teams
12. Enrollment status (e.g., undergraduate or graduate; full-time or part-time)
Should you decide to inform the institution not to release this information, the institution will honor your
request to withhold the information listed above but cannot assume responsibility to contact you for
subsequent permission to release them. Regardless of the effect upon you, the institution assumes no
liability for honoring your instructions that such information be withheld. If a student restricts his/her
directory information, the restriction continues until the student submits a written request for the restriction
to be removed.
Commencement & Alumni Wall Note: Students who have completed this form will be excluded from
publication in the commencement program and in all other public listings related to commencement and
graduation unless a written request to be included is submitted to the One-Stop Services Center (STE 230);
this may be submitted via Patriot email to the Enroll@uttyler.edu account. The deadline for this notice is the
Final Filing Deadline of the semester of graduation for commencement.
Please select one of the following options:
Restrict my Directory Information
Students may have all Directory Information withheld by notifying the Office of the Registrar in writing
by the Census Date of a semester. Requests for non-disclosure will be honored by the institution until
the student notifies the Office of the Registrar in writing that Directory Information may be released.
Un-restrict my Directory Information
Directory information may be released for any purpose at the discretion of the institution.
__________________________________ ______________________________
Student Name (Please print) Student Identification Number
__________________________________ ______________________________
Student Signature Date
The University of Texas at Tyler and the Office of the Registrar will exercise discretion in the release of all
directory information.
Return this form to the One-Stop Services Center (STE 230)
