FERPA
Revocation of Confidentiality/Directory Exclusion
This form is to be used to remove a previously requested Confidentiality/Directory Exclusion and allow SUNY Cobleskill to release
directory information from our student record in accordance with the Federal Family Rights to
Privacy Act of 1974 (FERPA). 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.
Additional information on FERPA and related policies can be found in the student handbook under Important Policies or on the
Registrar’s Office webpage.
Student Information
Name
Student ID (or Social Security) Number Contact Phone
Student Authorization:
By signing below, I hereby authorize SUNY Cobleskill to remove the
Confidentiality/Directory
Exclusion block from my student
records.
Student Signature Date
Requests will be honored within 4 business days of receipt.
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
