____________ ____________
Non-Disclosure Form
For Lee College Student Directory Information
Student: ID:
Under the Family Educational Rights and Privacy Act (FERPA), a federal law, institutions of higher education may
publish a list of releasable “directory information.” This information is primarily released for the purpose of
accountability and student migration studies and for verifying to potential employers that degrees and certificates
have been awarded, and/or that a student has been in attendance at the college.
Lee College’s directory information items, as published in the Lee College Catalog, are as follows:
1. Name
2. Address both Physical and Electronic
3. Telephone
4. Date and place of birth
5. Credentials earned and date as well as honors and awards
6. Major and field of study
7. Academic classification
8. Dates of attendance/Enrollment status
9. Number of semester hours in progress and attained to date
10. Previous high schools and colleges attended
11. Weight, height and participation of members of NJCAA athletic teams
Note: Lee College will never release grades or class schedule details to any other party without express written
consent from the student.
FERPA allows students to object to the release of directory information. Please sign below if you choose to invoke
this right. However, please understand that this action may delay the reporting of completion of degrees and
certificates, or college enrollment, to potential employers or other parties who may provide benefits or services
to college graduates or attendees.
I have read this form carefully and understand the consequences of my decision to prohibit the release of directory
information. I understand that upon submission of this form, all information about my attendance at Lee College
will be withheld from any third party (including potential employers, insurance agencies, providers of scholarships,
and financial institutions) without my written consent (unless the disclosure is allowed in specific rare situations
addressed by FERPA).
Signature: Date:
REVOCATION OF PREVIOUS REQUEST FOR NON-DISCLOSURE:
If you have previously requested the nondisclosure option regarding directory information under FERPA, you
may revoke it by signing below:
Signature: Date:
Office Use Only Processed by: Date: Updated 07/26/2017
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