Faculty Handbook - Fairmont State University
Faculty Handbook - Fairmont State University
Faculty Handbook - Fairmont State University
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AUTHORITY TO RELEASE PERSONALLY IDENTIFIABLE<br />
INFORMATION FROM EDUCATION RECORDS<br />
43<br />
Pursuant to the Family Educational Rights and Privacy Act of 1974, as amended,<br />
I,_________________________________________________________________, 1 give my consent to authorized<br />
representatives of <strong>Fairmont</strong> <strong>State</strong> <strong>University</strong> for the release of my educational records and<br />
any and all personally identifiable information contained therein, including educational<br />
information, employment information, and information contained in the records of FSU’s<br />
Student Affairs Office to<br />
__________________________________________________________________________________________________________ 2<br />
for purpose of_________________________________________________________________________________________<br />
__________________________________________________________________________________________________________ 3<br />
_________________________<br />
(Date)<br />
_____________________________________________________________<br />
(Signature)<br />
___________________________________________________________<br />
(Student Identification Number)<br />
NOTE: If an FSU student so requests, FSU shall provide him or her with a copy of the records<br />
disclosed.<br />
________________________<br />
1 Name of FSU student.<br />
2 Identification of party or class of parties to whom the disclosure may be made.<br />
3 Purpose of disclosure.