Fillable FERPA Directory Information & Opt-Out Form (El Camino Community College District)

Fill Online, Printable, Fillable, Blank FERPA Directory Information & Opt-Out Form (El Camino Community College District) Form

Use Fill to complete blank online EL CAMINO COMMUNITY COLLEGE DISTRICT pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FERPA Directory Information & Opt-Out Form (El Camino Community College District)

On average this form takes 7 minutes to complete

The FERPA Directory Information & Opt-Out Form (El Camino Community College District) form is 2 pages long and contains:

  • 1 signature
  • 0 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

U.S.A. forms for El Camino Community College District

BROWSE EL CAMINO COMMUNITY COLLEGE DISTRICT FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Office of Admissions & Records
FERPA Directory Information &
Opt-Out Form
FERPA Regulations
The Family Educational Rights and Privacy Act (FERPA), a Federal law requires that El Camino College
(ECC), with certain exceptions, obtain your written consent prior to the disclosure of personally identifiable
information from your education records. However, ECC may disclose appropriately designated “directory
information” without written consent, unless you have advised us to the contrary in accordance with District
procedures. The primary purpose of directory information is to allow ECC to include this type of
information from your education records in certain school publications. Examples include:
• A playbill, showing your role in a drama production
• Dean’s List
• Graduation programs
• Sports activity programs
Directory information, which is information that is generally not considered harmful or an invasion of
privacy if released, can also be disclosed to outside organizations without your prior written consent.
Outside organizations include, but are not limited to, federal and state agencies, companies that manufacture
class rings and/or graduations regalia, etc.
In addition, two federal laws require ECC to provide military recruiters, upon request, with your name,
addresses, and telephone number unless you have advised us that you do not want your information disclosed
without prior written consent.
Directory Information Opt-Out Procedures
If you do not want ECC to disclose directory information from your education records without your prior
written consent, you must notify us in writing. For your convenience, please complete this form and return it
to the Admissions & Records Office. Upon receipt, your information will not be released from the time this
request is processed forward. If directory information is released prior to receiving your opt-out request,
ECC may not be able to stop the use of your information.
Directory Information at El Camino College:
Name
Photograph
Dates of Attendance
Enrollment Status (e.g., full-time, part-time)
Class Standing (e.g. sophomore)
Participation in officially recognized activities and sports
Weight and height of members of athletic teams
The most recent educational institution attended
Degrees, certificates, honors, and awards received
Major field of study
FERPA DIRECTORY INFORMATION OPT- OUT FORM
Please print Cleary and in ink (for printed forms):
ECC Student ID # ___/___/___/___/___/___/___ / Telephone # _______ ___________ - ___________
Name: _________________________________________________ Email: _______________@_________
Last First MI
Notice of Directory Information
9/2018
To: Registrar of El Camino 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 El Camino 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 ECC receives my Opt-Out Form until my opt-out request is
rescinded. I understand that I may not opt-out of use of my student ID because it is necessary for identifying
information for ECC. I further understand that if directory information is released prior to ECC receiving
my opt-out request, ECC may not be able to stop the disclosure of my directory information.
Signature ________________________________________________ Date: ____/_____/20______
Office Use Only
Date received: ____/_____/______ Date records coded: ____/_____/______ Initials: ____________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FERPA Directory Information & Opt-Out Form (El Camino Community College District)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 4 September 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document