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Privacy Form

The Family Education Rights and Privacy Act

Academic Year 2007

DIRECTORY EXCLUSION OPTION available to all students:

Please consider your decision carefully before requesting directory information exclusion.  It will mean that no other students or outside agencies will be able to contact you by mail or phone unless you have personally given them your address and/or telephone number.  A separate release form with your signature will be required each time you need to provide directory information to any outside agency.  UMDNJ designates "directory information" as:

Name, address, e-mail address, class schedule, telephone listing, photograph, date and place of birth, major field of study, participation in officially recognized activities, course schedule, dates of attendance, degrees and awards received, and the most recent previous educational institution attended by the student, and residency or other internship or post-completion placement.

The Family Education Rights and Privacy Act (FERPA) is a Federal law designed to protect the confidentiality of student records.  This applies to the release of all data except for information called "directory information".  Under the provisions of FERPA, the University is permitted to provide information of a "directory" nature without written consent, unless the student specifically requests that such information not be disclosed.

Additional details on FERPA are published in the UMDNJ-Robert Wood Johnson Medical School Catalog and on the next page.   

 

Directory Exclusion for Academic Year 2007

I request that my directory information not be released.

 

_____________________________________

Signature                                          Date

 

_____________________________________

Printed Name

 

_____________________________________

Social Security Number

 

The response to requests for an address or phone number will be that the information is being withheld at the student's request.  This request will be honored for the current academic year only.  Deadline for filing is August 31.  A new request must be filed with the Registrar at the beginning of each academic year.

The Family Educational Rights and Privacy Act (FERPA)

The Family Educational Rights and Privacy Act (FERPA) gives students certain rights with respect to their education records.  They are:

1.         The right to inspect and review your education records within 45 days of the day the University receives a request for access.  Students should submit to the Registrar a written request that identifies the record(s) they wish to inspect.  The Registrar will make arrangements for access and notify the student of the time and place where the records may be inspected.  If the records are not maintained by the Registrar, the student will be advised of the correct official to whom the request should be addressed.

2.         The right to request the amendment of the student's education records that the student believes are inaccurate or misleading.  The student should write to the Registrar and clearly identify the part of the record they want changed, and specify why it is inaccurate or misleading.  If the University decides not to amend the record as requested, the University will notify the student of the decision and advise the student of his or her right to a hearing regarding the request for an amendment.  Additional information regarding the hearing procedure will be provided to the student when notified of the right to a hearing.

3.         The right to consent to disclosures of personally identifiable information contained in the student's education records, except to the extent that FERPA authorizes disclosure without consent where the information is classified as "directory information."

The following categories have been designated as directory information: name, address, class schedule, telephone listing, photograph, date and place of birth, major field of study, participation in officially recognized activities, dates of attendance, degrees and awards received, and the most recent previous educational institution attended by the student, and residency or other internship or post-completion placement.       

Disclosure of personally identifiable information contained in the education record is permitted to school officials with legitimate educational interests.  A school official is a person employed by the University in an administrative, supervisory, academic or research, or support staff position (including law enforcement unit personnel and health staff); a person or company with whom the University has contracted (such as an attorney, auditor, or collection agent); a person serving on the Board of Trustees; or a student serving on an official committee, such as a disciplinary or grievance committee, or assisting another school official in performing his or her tasks.

A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibility.

The University forwards education records without consent on request to officials of educational programs that are administered jointly with RWJMS in which a student seeks or intends to enroll.

4.         The right to file a complaint with the U.S. Department of Education concerning alleged failures by UMDNJ to comply with the requirements of FERPA.  The name and address of the Office that administers FERPA is:

Family Policy Compliance Office

U.S. Department of Education

400 Maryland Avenue, SW

Washington, DC 20202-4605