Revised: September 2016 Office of Records & Registration
REQUEST TO PREVENT DISCLOSURE OF DIRECTORY INFORMATION
Submit completed form to the Records Office via email at records@ggu.edu
, via fax to (415) 442-7223, or in-person or via mail
to: Golden Gate University, Office of Records and Registration, 536 Mission Street, San Francisco, CA 94105-2968. Your request
will be processed on the date received. Please allow additional time for delivery by mail.
Golden Gate University does not normally disclose students’ directory information to outside organizations or persons.
However, at its discretion, it may release directory information in accordance the Family Educational Rights and Privacy Act
(FERPA) of 1974, as amended. At Golden Gate University, directory information is limited to the following:
• Full name
• Address
• Telephone number
• Email address
• Dates of attendance
• Enrollment status
• Program of study and
concentration(s)
• Participation in officially
recognized activities
• Awards
• Honors (including Dean’s
List)
• Degree(s) earned and
date(s) conferred
• ID card photograph
Under the provisions of FERPA, students have the right to withhold the disclosure of directory information. Students may
request non-disclosure of directory information by submission of this form at any time to the Registrar’s Office.
Golden Gate University will honor your request to withhold all directory information items, but cannot assume responsibility to
contact you for subsequent permission to release them. After your request goes into effect, you will be required to provide a
signed release in order for any of your directory information to be disclosed to outside organizations or persons. Your request
for non-disclosure will remain in effect until rescinded by you in writing. Please consider very carefully the consequences of
any decision by you to withhold the release of directory information.
Please note: Non-disclosure of directory information does not prevent Golden Gate University from disclosing personally
identifiable information, including directory information, from a student’s record to authorized representatives of federal,
state, and local agencies when that disclosure is in connection with financial aid for which the student has applied or which
the student has received, or any of the other exceptions to signed consent found in the FERPA regulations.
For Law School Students:
This request will prevent Golden Gate University from releasing your directory information to the following organizations, but
will not prevent you from being eligible for the awards they sponsor:
• The Witkin Legal Institute, sponsors of the Witkin Award for Academic Excellence, which recognizes exceptional
California law school students
• The Center for Computer Assisted Legal Instruction, sponsors of the Excellence for the Future Awards, which recognizes
exceptional law school students
STUDENT INFORMATION:
GGU ID Number: ________________________________
Last (family) Name: ______________________________________ First (given) Name: ___________________________
Email Address: __________________________________________ Daytime Phone: ______________________________
I have read this form carefully and understand: 1) the consequences of my decision to withhold my directory information; 2)
the exceptions to this directive as stated above, and; 3) that this directive will remain in effect until I submit a written request
to revoke it.
Student’s Signature: _____________________________________________ Date: ___________________
Date Received and Recorded: _____________ Privacy Code Entered By: __________________________
click to sign
signature
click to edit
![]()
