Authorization to Disclose Information to Parents of Non-Dependent Students

Student’s Name_________________________ (please print)

Campus Wide I.D. or Social Security # ____________________

 

AUTHORIZATION TO DISCLOSE ACADEMIC-FINANCIAL- DISCIPLINARY
INFORMATION TO PARENTS FOR NON-DEPENDENT STUDENTS
(Parents of dependent children will automatically have access to their son or daughter’s information)

In accordance with FERPA, the University will disclose to parents information from the academic, financial or disciplinary of a student provided the University has on file written consent of the student. Please sign below and return to the Office of Student Records if you consent for the University to release to your parents your educational records.
 

 

_______________________________________________________
Student’s Signature                                                                Date
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AUTHORIZATION TO WITHHOLD DIRECTORY INFORMATION


The following is considered "Directory Information" at Loyola University New Orleans and will be made available to the general public unless the student notifies the Office of Student Records in person or in writing before the last day to add classes.

Student's name, telephone numbers, all addresses, e-mail address, place of birth, college, major, honors, awards, enrollment status, classification, dates of enrollment, degrees conferred, dates of conferral, graduation distinctions and the institution attended immediately prior to admission.
Under the provisions of the Family Educational Rights and Privacy Act of 1974 you have the right to withhold disclosure of such Directory Information. Loyola University New Orleans will honor your request to withhold Directory Information.

Please consider carefully the consequences of any decision to withhold such Directory Information. Should you decide to inform Loyola University New Orleans not to release any of this information, any requests for such information from Loyola University New Orleans will be refused.
This signed request must be received in the Office of Student Records by 4:45 p.m. on the last day to add classes as listed in the Academic Calendar. This authorization is valid until a written request to rescind is received by the Office of Student Records.

I hereby request that Loyola University New Orleans not release any Directory Information from my academic records. I have read the above paragraphs and understand the consequences of my action.
 

 

______________________________________________________

Student’s Signature                                                         Date
 

FAX THIS FORM TO – 504-865-2110 OR BRING IT TO THE OFFICE OF STUDENT RECORDS – MARQUETTE 250