UNIVERSITY OF ILLINOIS AT SPRINGFIELD
Office of Records and Registration
Request to Revoke Previous Request to
Prevent Disclosure of Directory Information
Please complete, print (see "Print Form" button above), sign, and return this form to the Office of Records and Registration, University Hall, One
University Plaza, MS UHB 1076, Springfield, IL 62703-5407. Forms are processed on a weekly basis. Please be sure to carefully complete all
information prior to printing the document.
Last Name First Name
UIN
Records (217) 206-6709 Degree Audits (217) 206-8216 Registration (217) 206-6174 Graduation (217) 206-7730
For Office Use Only
Processed By:
Date:
Student Signature
Under the provisions of the Family Educational Rights and Privacy Act of 1974, as amended, you have the right to withhold the disclosure of any
"Directory Information" (information which is available to the public).
Date
After careful consideration, you have decided to revoke your previous request to prevent disclosure of Directory Information.
Please sign and date the form below if you do wish to revoke your previous request to prevent disclosure of Directory Information. This disclosure
will remain in effect until you provide written notice to the Office of Records and Registration to reactivate the non-disclosure.
This form should be submitted to the Office of Records and Registration prior to the tenth class day of the semester (fifth day of the summer
term).
Copy (distributed by the Office of Records and Registration):
Original:
Student
Permanent File
