Fillable FERPA Directory Information (Henry Ford College)

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FERPA Directory Information (Henry Ford College)

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Registration and Records
FERPA Directory Information
Opt-Out Form
Notice Of Directory Information Opt Out
In accordance with the Federal Educational Rights and Privacy Act of 1974 (FERPA), as
amended, a student’s education records are maintained as confidential and, except for a
limited number of special circumstances listed in that law, will not be released to a third party
without the parent/student’s prior written consent. The law, however, does allow schools to
release student “directory information” without obtaining the prior consent of the
parent/student. If you do not want the release of directory information, you may choose to “opt-
out” of this FERPA exception by signing the below. Directory information of a student who has
opted-out from the release of directory information, in accordance with this policy/procedure for
opting out, will remain flagged until the student requests that the flag be removed by
completing and submitting a revocation of the opt out to the Registrar’s Office. The following
information is what HFC considers directory information:
a. Name
b. Photograph
c. Dates of Attendance
d. Enrollment Status (e.g., full-time, part-time)
e. Class Standing (e.g. sophomore)
f. Participation in officially recognized activities and sports
g. Awards and honors received
h. Degrees conferred
i. Enrollment dates
j. Major
k. Anticipated date of graduation
Registration and Records
FERPA Directory Information
Opt-Out Form
Student Information
Name (printed): ____________________________________
HANK ID Number: ____________________________________
To: Henry Ford College
I request the withholding of the above-referenced personally-identifiable information identified as
Directory Information. I understand that upon submission of this Form, the information above cannot
be released to third parties without my written consent or unless Henry Ford College is required by
law or permitted under FERPA to release such information without my prior written consent; and that
the directory information will not otherwise be released from the time Henry Ford College receives my
Form until my opt out request is rescinded. I understand that I may not opt out of use of my Student
ID Number because it is necessary for identifying information for Henry Ford College. I further
understand that if directory information is released prior to Henry Ford College receiving my opt out
request, Henry Ford College may not be able to stop the disclosure of my directory information. I
understand that I may request and challenge how my directory information is used by contacting the
Registrar’s Office.
Signature: ____________________________________ Date: ____________
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FERPA Directory Information (Henry Ford College)

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Completed 17 September 2020

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