EIS Student Records Access Authorization Form
All faculty, staff, students and visitors (contractors, consultants, etc..) requesting access to student data in EIS (Enterprise
Information System) are required to complete the Family Education Rights Privacy Act of 1974, as Amended (FERPA)
training through LearnHSC managed by Institutional Compliance and Integrity. Download and submit your FERPA
training certificate along with this form to the UNTHSC Registrar’s Office at registrar@unthsc.edu.
I understand that by virtue of employment or contract with the University of North Texas Health Science Center, I may have access
to records that contain individually identifiable information, the disclosure of which is prohibited by the Family Educational Rights
and Privacy Act of 1974, as Amended (FERPA).
I acknowledge that I fully understand that the intentional disclosure by me of this information to any unauthorized person could
subject me to criminal and civil penalties imposed by law. I further acknowledge that such willful or unauthorized disclosure also
violates University of North Texas Health Science Center policy and could constitute just cause for disciplinary action including
termination of my employment regardless of whether criminal or civil penalties are imposed.
Agreement
By signing this form, I am affirming that I have reviewed/completed and understand all the information regarding FERPA
provided on the LearnHSC training website managed by Institutional Compliance and Integrity .
I understand that all information contained in EIS is regulated by university policy and procedures. Any unauthorized use of these
systems could result in the loss of Student Record Access and possibly disciplinary or criminal action.
ALL INFORMATION BELOW IS REQUIRED BEFORE ACCESS CAN BE UPDATED IN EIS.
UNTHSC Fac
ulty/Staff/Student Access:
_______
______________________________________ ____________________________________
Printed Name
Date Requested
____________________________________________ ____________________________________
Signature EMPLID & EUID
____________________________________________ ____________________________________
Department Job Title
____________________________________________
UNTHSC Email
_____________________________________________ ____________________________________
Supervisor (Print)
Supervisor (Signature)
Non-HSC Employee
_______
___________________________________________
Name (i.e. Contractors, consultants, etc.)
_____________________________________________________________________________________________________
Purpose for access
_____________________________________ ____________________________________
Company/Business Name
Last date access required
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