Fillable Request for Non-Disclosure of Directory Information (Pierce College at Puyallup)

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Request for Non-Disclosure of Directory Information (Pierce College at Puyallup)

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Request for Non-Disclosure of Directory Information
Family Educational Rights and Privacy Act (FERPA) of 1974
20 USC § 1232g and 34 CFR § 99
Instructions to Student: Carefully read the information below. After
completing the form, make a copy for your records and submit the original
copy to the Registration Office.
The items listed below are designated as “Directory Information” at Pierce College and
may be released for any purpose at the discretion of the College.
Name, Dates of Enrollment, Degrees, Awards and Honors Awarded, Enrollment
Status, Participation in Officially Recognized Activities and Sports, and the Weight
and Height of Members of Athletic Teams
Under the provisions of the Family Educational Rights and Privacy Act (FERPA) of
1974, as Amended, you have the right to withhold the disclosure of your Directory
Information.
Please consider very carefully the impact of your decision to withhold your Directory
Information. Should you request that Pierce College not release your Directory
Information, any requests for the information from non-institutional persons or
organizations will be refused. FERPA allows students the right of non-disclosure of
directory information only. Pierce College may disclose information, even if you request
otherwise, under the exceptions to FERPA’s consent requirement (34 CFR § 99.31).
Please complete the following statement and sign below.
I, _____________________________________________,
(Print Name)
_______ _____ _______
-- --
(Student I.D. Number)
Request that Pierce College not release my directory information. I understand that
my Request for Non-Disclosure of Directory Information will remain in effect until I
notify the Registrar’s Office at Pierce College in writing to cancel it or for any
exceptions to non-disclosure of directory information, e.g., degree verifications by
potential employers. I understand that Pierce College assumes no liability for
honoring my request for non-disclosure of directory information.
Signature: ___________________________________________ Date: _____________
Ctj02/00;revised 08/01;05/03
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Request for Non-Disclosure of Directory Information (Pierce College at Puyallup)

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Completed 9 October 2020

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