Office of the University Registrar
25 University Avenue, West Chester, PA 19383
Ph: 610-436-3541
Fx: 610-436-2370
Student Name: _________________________________________________________________________
Under the provisions of the Family Educational Rights and Privacy Act of 1974, as amended, a student has the
right to request an institution withhold the disclosure of the “Directory Information” listed below. This
complete policy can be found in the West Chester University Graduate and Undergraduate Course Catalogs, as
well as the Ram’s Eye View. Completion of this form restricts the release of the information outlined below,
until the student notifies the Office of the Registrar, in writing, that they would like to revoke this request.
The items listed below are designated “Directory Information” and may be released for any
purpose at the discretion of our institution:
Student’s name
Local and
Email address,
which includes
WCU student ID
Date and place of birth
Major field of study
Dates of attendance
Enrollment status
Expected graduation
Degrees, awards, and
honors received
Most recent previous
educational agency or
institution attended
by the student
Participation in officially
recognized activities and
Weight and height, if a
member of an athletic
I have carefully considered the consequences of my decision to request West Chester University
withhold the above information. I understand that once submitted, this information will be
restricted until I request otherwise. I accept that the university is not responsible to contact me
regarding any disclosure requests received on my behalf. I further understand that the university
may not be held liable for honoring this request to withhold “Directory Information.”
Warning: Restricting the release of directory information means your name will not be printed in the
Commencement Brochure and WCU will not be able to verify your enrollment or degree without your
prior written consent.
I do not want this “Directory Information” disclosed.
Student’s Signature: ________________________________________________________
Date: __________________________
IMPORTANT NOTICE: This form will be processed and
posted to your record on the FRIDAY after it has been
received in the Office of the Registrar. It is the
responsibility of the student to file this form prior to
academic publications.
Return this form to the Office of the Registrar. Incomplete forms will not be processed.
Rev. 3/15