Request to Withhold Release of Directory Information
With rescind option
Directory Information
Fontbonne University has designated certain information contained in the education records of its students as
Directory Information. This includes: (1) full name, (2) local and home addresses, (3) local and home
telephone numbers, (4) e-mail address, (5) date and place of birth, (6) most recent educational institution
attended, (7) enrollment status, (8) class level, (9) dates of attendance, (10) degrees, awards, and honors
received, (11) participation in officially recognized activities and sports, (12) weight and height of athletic team
members, and (13) photographs.
Fontbonne University may disclose Directory Information for any purpose, without the prior consent of a
student, unless the student has forbidden its disclosure in writing. Students wishing to prevent release of the
designated Director Information should file a written notification by completing this form and returning it to
the Registrar’s Office within two (2) weeks of the start of the semester. This form will stay in effect until the
Fall term of the next academic year. The University will assume that a student does not object to the release
of the Directory Information unless the student files this form in a timely fashion.
Effect of Preventing Release of Directory Information
Please consider very carefully the consequences of filing this form. Should you request Fontbonne University
to withhold release of Directory Information, any future requests for such information from non-institutional
persons or organizations will be refused while this form is in effect. This request will be enforced until the
student revokes it in writing or the beginning of the next Fall term, except as noted below.* The University
will honor this request without exception and is not responsible for any effect the University’s compliance
with this request may have on you.
Requesting to withhold release of Directory Information will preclude Fontbonne University from
confirming your attendance or, if in effect upon graduation, * the degree you attained for employment,
credit or other purposes.
Submission of this form is an indication of my desire to withhold the release of Directory Information. My
signature is an indication that I fully accept the responsibility to notify the Registrar’s Office, in writing, if I
subsequently wish to allow the release of Directory Information. I understand I must indicate my desire to
withhold the release of Directory Information annually.
__________________________________________________________________________________________
Name Student ID# Last 4 SSN
*If you plan on graduating this term, and wish to allow the release of Directory Information starting the day
prior to graduation, please check this box: □
___________________________________________________________ ______________________________
Student Signature (physical signature required) Date
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