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Ferpa Directory Form

The document is a form from Sandhills Community College regarding a student's right to restrict the release of their directory information under FERPA. It explains that directory information, such as a student's name, photo, major of study and dates of attendance, can be disclosed publicly by the college unless the student requests otherwise using the provided form. The form collects the student's identifying information and requires their signature to request that no directory information associated with their educational records be released for the specified semester and year.

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78 views1 page

Ferpa Directory Form

The document is a form from Sandhills Community College regarding a student's right to restrict the release of their directory information under FERPA. It explains that directory information, such as a student's name, photo, major of study and dates of attendance, can be disclosed publicly by the college unless the student requests otherwise using the provided form. The form collects the student's identifying information and requires their signature to request that no directory information associated with their educational records be released for the specified semester and year.

Uploaded by

api-313957120
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Family

Educational Rights and Privacy Act


(FERPA)
DIRECTORY INFORMATION FORM


The Family Education Rights and Privacy Act (FERPA), a Federal law, requires that Sandhills Community College (SCC), with certain
exceptions, obtain your written consent prior to disclosure of personally identifiable information from your education records.
However, SCC may disclose appropriately designated directory information to the general public without written consent, unless
you formally request that your directory information not be released by the college.

Sandhills Community College defines the following as directory information:
-The students name -City and county of residence
-Photograph -Major field of study
-Participation in officially recognized activities and sports -Dates of attendance
-Grade level -Degrees, honors, and awards received
-The most recent educational agency or institution attended by the student -Student email address

If you would like to request for SCC not to release directory information in your education record, please complete the form below no
later than two weeks after the first day of classes each semester.








Students
Last Name
(Print)

Students SCC ID
Number

Students
First Name
(Print)

Students
Date of Birth

Students
MI
(Print)

Effective
Semester
and Year


I understand that this
request will remain in
effect for the above
term/year only.

I request that Sandhills Community College does not release directory information from my educational record. I understand that
this request must be submitted no later than two weeks after the first day of the semester for the request to be honored during the
term. I also understand that this request is only valid for one semester, which Ive noted above. If I wish to continue the request, I
must complete a new form each semester.
Student Signature REQUIRED:

Date:

Send completed form by mail or deliver in person to:


Sandhills Community College, ATTN: Director of Records and Registration
Stone Hall-Office 119, 3395 Airport Rd., Pinehurst, NC 28374

***FOR SCC OFFICE USE ONLY***


Witnessed by SCC Official
(Printed name):

Title:

Signature of SCC Official:

Date:








Revised 7.23.15 lhf

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