NATIONAL PARK COLLEGE
REQUEST TO PREVENT DISCLOSURE
OF DIRECTORY INFORMATION
If this form is not received in the Registrar’s Office prior to the 1
st
day of classes of the
semester attending, it will be assumed that the information below may be disclosed for
the current academic term until a signed form is received by the Registrar. A new form
for non-disclosure must be completed each academic semester.
For __________________________________ NPC ID _______________
(printed name of student)
specifically pertaining to the _____________ semester, 20____
The items listed below as “Directory Items” are considered public information and may
be made available upon inquiry unless the student has submitted a signed request for
nondisclosure for the specific enrollment period. Under provisions of the Family
Educational Rights and Privacy Act of 1974, you have the right to withhold disclosure of
the Directory Items listed below.
DIRECTORY ITEMS INCLUDE: Student name, address, e-mail address,
telephone number, place and date of birth, citizenship status,
number of academic hours completed, academic major, full-time or
part-time enrollment status, academic and nonacademic honors,
other academic institutions attended, degree obtained and date conferred,
campus activities, leadership positions, and dates of attendance.
BEFORE SIGNING THIS FORM please consider very carefully the consequences of
any decision by you to withhold directory information. Any future requests for such
information from non-institutional persons or organizations pertaining to this academic
term will be refused. The institution will honor your request to withhold the listed items,
but cannot assume responsibility to contact you for subsequent permission to release
them for any purpose.
Affix your signature below to indicate that the institution is not to disclose the specified
disclosure information.
Student Signature: __________________________________
Date: ______________________
Submit this form to:
Office of the Registrar
National Park College
101 College Drive, Hot Springs, AR 71913
mm/dd/yyy
click to sign
signature
click to edit
![]()
