FERPA
Confidentiality/Directory Exclusion Request
What
is
Directory
Information?
Under the provisions of the Federal Family Education Rights and Privacy Act of 1974 (FERPA), Colleges may disclose information about a student
designated as “directory information.” This information can, by law, be released to the general public and may be listed in the campus directory. SUNY
Cobleskill has designated the following as Directory Information:
Student Name
Campus, local and home addresses
Phone number
Major
Department
Dates of Attendance
Dates of Graduation
Degrees Awarded
Awards
Full-time/part-time Status
Date of Birth
Email Address
Photo/Video Footage
No other student information is released to non-university personnel without written permission.
You have the right to withhold disclosure of directory information. By completing this form, you will be requesting that information NOT be
released to non-university personnel or listed in the campus directory.
To be
considered
!
Please consider the consequences of a decision to withhold directory information. Should you decide not to release any of this information; any requests
for such information will be refused. Some effects may be:
Friends, relatives, faculty or other students will not be able to access your contact information while a student or after you become an alum
Information will be suppressed, so that if a loan company, perspective employer, family member, etc., inquire about you, they will be informed
that we have no record.
Your name will not be included in announcement of honors, awards or in the program for commencement.
L
imitations
Confidentiality/Directory Exclusions does not limit access to your file by authorized individuals nor does it apply to employment information. It does not
prevent disclosure of personally identifiable information from a student’s record to authorized representatives of federal, state, and local agencies, or any
of the other exceptions to signed consent found in FERPA regulations. Information can be released to comply with a judicial order or lawfully executed
subpoena.
SUNY Cobleskill cannot assume responsibility to contact you when information about you is requested. Regardless of the effect upon you, the institution
assumes no liability for honoring your instructions that such information be withheld.
THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL REVOKED USING THE FERPA REVOCATION OF
CONFIDENTIALITY /DIRECTORY EXCLUSION FORM.
Student Information
Name
Student ID (or Social Security) Number Contact Phone
Student Authorization:
By signing below, I hereby request SUNY Cobleskill not release any directory information from my academic records. I have read
the above paragraphs and understand the consequences of this request for exclusion.
Student Signature Date
Current students must complete and submit this form within 14 days of the start of classes for their Directory Information to be excluded. Requests will be
honored within 4 business days of receipt. Additional information on FERPA and related policies can be found in the Student Handbook under Important
Policies or on the Registrar’s Office webpage.
Completed forms must be presented in person, with appropriate identification, or mailed to SUNY Cobleskill, Office of the Registrar, Knapp Hall
101, State Route 7, Cobleskill, NY 12043.
Requests received by mail must be notarized or they will not be processed.
Notary Public’s Signature Date
NOTARY SEAL
