Request for Computer Access to Student Information
April 2010
Name: ___________________________________________ JU ID#: _________________
Department: ___________________________________________ Position: _________________
Responsibilities that require access to student records:
I understand that access to records that contains personal, academic and financial information
carries responsibilities. That the disclosure of information to unauthorized individuals or groups
violate The Family Educational Rights and Privacy Act (FERPA) of 1974 and Jacksonville
University policy. I acknowledge that I fully understand that the discourse of information may
subject me to criminal and civil penalties imposed by law. I further acknowledge that such
willful or unauthorized disclosure also violates JU’s policy and could constitute just cause for
disciplinary action including termination of my employment regardless of whether criminal or
civil penalties are imposed. The AACRAO 2001 Guide page 157
Employee Signature Date
Supervisor’s Signature Date
Approved for Security Class(es) Admissions/Registrar Official
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