STUDENT CONSENT TO DISCLOSURE
and WAIVER OF FERPA RIGHTS
Lane Community College Employees Federation (LCCEF) has requested certain
information regarding College-employed student workers. The College is required to
provide certain information, but because your student worker employment records are
educational records, the College may not disclose your name in response to this request
without your consent and waiver of your Federal Educational Rights and Privacy Act
(FERPA) rights.
Department: ____________________
Supervisor Name:__________________
Student Position:__________________
Date: _______________________
I hereby(CHECK ONE)____consent
_____do not consent
to allow the College to disclose my name to the LCCEF union management, in response
to their request for College student worker information. I understand that the Union has
an obligation to treat this information as confidential, and will not disclose the
information to anyone other than authorized union representatives.
This consent is valid only for as long as I am employed in my current position in the
above department .
I understand that I have the right to revoke this consent and waiver at any time by
providing written notice to the Human Resources Department at Lane Community
College.
Printed Name L number
Signature Date
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