FERPA Consent

Name

Organization and Position/Seat

FSU Email

I, the undersigned student, hereby authorize the Florida State University Department/College of Student Government Association to release my educational records and information as specified below for the limited purpose of posting such information on the Department/College website. The only type of information that is to be released under this consent is (Please check all that apply):

My appointment as a Teaching Assistant, Research Assistant, Graduate Assistant, Student Assistant, or Program Participant.
My office location, office hours and campus phone number (if any) associated with my appointment in the above role.
My FSU email address
A summary of my background
My Photo
My CV or Resume
Other

If other, please provide a description of the information that may be released

I understand that some of my educational records are protected under the Family Educational Rights and Privacy Act of 1974 and cannot be released without my written consent. I certify that this consent has been given freely and voluntarily. I may revoke this consent at any time by providing written notice of such revocation to the University office or person who maintains the record of this consent. I further understand that until any revocation is made, this consent shall remain in effect and my educational records and information (as specified above) will continue to be provided to the College/Department named above for the specific purpose described above.

Student Signature

Sign Here

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