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doc10985 CCP-FERPA-Student-Release-Form-artifacted.pdf
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Page 1
32 item(s)
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figure (1)
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1 · HEADER
2 · FIGURE
3 · TITLE
4 · TEXT
5 · TEXT
6 · TEXT
7 · TEXT
8 · TEXT
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"text": "Stark State College\nGateway Student Services\n6200 Frank Ave NW, North Canton, OH 44720\n(330) 494-6170 | Fax-(330) 966-6598\nwww.starkstate.edu | studentservices@starkstate.edu",
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"text": "I, the undersigned, hereby authorize Stark State College to release the following educational records or information to the company and/or contact person listed below:"
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"text": "I understand that 1) I have the right not to consent to the release of my education records; 2) I have the right to obtain a copy of such records upon request; and, 3) this consent shall remain in effect until revoked by me, in writing, and delivered to the Stark State College Academic Records/Registrar's Office, but that such revocation shall not affect disclosures previously made by Stark State College."
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"text": "THIS INFORMATION IS RELEASED SUBJECT TO THE CONFIDENTIALITY PROVISIONS OF 20 U.S.C. 1232g(b)(4)(B) WHICH PROHIBITS ANY FURTHER DISCLOSURE WITHOUT THE SPECIFIC WRITTEN CONSENT OF THE PERSON TO WHOM IT PERTAINS, OR AS OTHERWISE PERMITTED BY FEDERAL LAW."
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