Request to Prevent Disclosure of Directory Information
Pursuant to the Family Educational Rights and Privacy Act of 1974 and amendments
thereto, you have the right to prevent the disclosure of “Directory Information,” which
otherwise may be released for any purpose at the discretion of Nova Southeastern
University (NSU). The items listed below are presently designated by NSU as Directory
Information:
Student name Dates of attendance
Local and home address Degrees, honors and awards received
Telephone numbers Enrollment status
Major field of study Year in school
Participation in sports Anticipated graduation date
Place of birth Email addresses
Photo ID
NSU reserves the right to change the categories of Directory Information at any time.
Please Note: Consider very carefully the consequences of your request to not disclose
Directory Information to persons or organizations outside NSU. NSU shall comply with
your request, except as otherwise required by law. NSU shall not be liable or
responsible for honoring your request.
Student I.D. ___________________ Student’s Name: ____________________________________
Last First MI
____________________________________________________________ _______________________
Permanent Address (Mailing Address, City, State Zip) Phone Number
Student’s Signature: ____________________________________ Date:______________________
Sign and submit to the One-Stop Shop on the Fort Lauderdale/Davie campus (Horvitz
and Terry Administration Buildings), email to nsuregistrar@nova.edu, or mail to NSU,
Office of the University Registrar, 3301 College Avenue, Fort Lauderdale, FL 33314.
______________________________________________________________________
FOR OFFICE USE ONLY
Entered by:_________________________________________________ Date:____________________
