{ "document_id": 10985, "filename": "CCP-FERPA-Student-Release-Form-artifacted.pdf", "engine": "paddleocr_vl", "source_run_id": 11096, "generated_at": "2026-10-27T17:09:44+00:00", "page_count": 1, "counts_by_type": { "figure": 1, "form_field": 6, "header": 1, "text": 23, "title": 1 }, "timings": { "total_ms": 2364, "structure_ms": 192, "text_layer_ms": 8, "build_ms": 3 }, "pages": [ { "document_id": 10985, "page": 1, "width": 612, "height": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 11096, "item_count": 32, "counts_by_type": { "figure": 1, "form_field": 6, "header": 1, "text": 23, "title": 1 }, "build_ms": 3, "items": [ { "id": "p1.1", "order": 1, "type": "header", "bbox": { "l": 44.64, "t": 770.4, "r": 249.84, "b": 699.12 }, "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", "attrs": { "block_label": "header" }, "level": 2, "reading_order": 0 }, { "id": "p1.2", "order": 2, "type": "figure", "bbox": { "l": 456.96, "t": 770.4, "r": 567.36, "b": 702.48 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" }, "reading_order": 1 }, { "id": "p1.3", "order": 3, "type": "title", "bbox": { "l": 134.16, "t": 680.88, "r": 476.88, "b": 664.56 }, "text": "FERPA RELEASE FOR COMPANY OR ORGANIZATION", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 2 }, { "id": "p1.4", "order": 4, "type": "text", "bbox": { "l": 223.92, "t": 657.84, "r": 387.84, "b": 645.36 }, "text": "Please print in blue or black ink only.", "reading_order": 3 }, { "id": "p1.5", "order": 5, "type": "text", "bbox": { "l": 50.4, "t": 627.36, "r": 383.52, "b": 613.2 }, "text": "Student Name ___\nStudent ID# ___", "reading_order": 4 }, { "id": "p1.6", "order": 6, "type": "text", "bbox": { "l": 390, "t": 627.6, "r": 562.08, "b": 612.48 }, "text": "Student ID#", "reading_order": 5 }, { "id": "p1.7", "order": 7, "type": "text", "bbox": { "l": 387.6, "t": 605.76, "r": 562.08, "b": 590.88 }, "text": "Date of Birth ___", "reading_order": 6 }, { "id": "p1.8", "order": 8, "type": "text", "bbox": { "l": 49.68, "t": 574.32, "r": 535.68, "b": 546.48 }, "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:", "reading_order": 7 }, { "id": "p1.9", "order": 9, "type": "text", "bbox": { "l": 82.8, "t": 533.28, "r": 259.92, "b": 519.6 }, "text": "All academic educational records.", "reading_order": 8 }, { "id": "p1.10", "order": 10, "type": "text", "bbox": { "l": 83.04, "t": 507.6, "r": 546.96, "b": 467.28 }, "text": "□ The following specific records (such as grades, GPA, Class Rank): ___", "children": [ { "id": "p1.10.1", "order": 11, "type": "form_field", "bbox": { "l": 83.04, "t": 507.6, "r": 95.04, "b": 495.6 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "□ The following specific records (such as grades, GPA, Class Rank): ___", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p1.10", "text_offset": 0, "text_span": 1 }, "reading_order": 0 } ], "reading_order": 9 }, { "id": "p1.11", "order": 12, "type": "text", "bbox": { "l": 51.12, "t": 451.68, "r": 547.92, "b": 436.32 }, "text": "Company Name ___", "reading_order": 10 }, { "id": "p1.12", "order": 13, "type": "text", "bbox": { "l": 50.4, "t": 428.88, "r": 547.44, "b": 415.44 }, "text": "Contact Name ___", "reading_order": 11 }, { "id": "p1.13", "order": 14, "type": "text", "bbox": { "l": 50.16, "t": 407.52, "r": 548.16, "b": 391.92 }, "text": "Address", "reading_order": 12 }, { "id": "p1.14", "order": 15, "type": "text", "bbox": { "l": 49.44, "t": 374.4, "r": 532.8, "b": 360.48 }, "text": "The release of the educational records or information as stated above are for the following purpose(s):", "reading_order": 13 }, { "id": "p1.15", "order": 16, "type": "text", "bbox": { "l": 82.8, "t": 348.48, "r": 254.64, "b": 334.08 }, "text": "College Admissions Application", "reading_order": 14 }, { "id": "p1.16", "order": 17, "type": "text", "bbox": { "l": 83.76, "t": 326.88, "r": 169.68, "b": 312.72 }, "text": "□ Employment", "children": [ { "id": "p1.16.1", "order": 18, "type": "form_field", "bbox": { "l": 83.76, "t": 326.88, "r": 95.76, "b": 314.88 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "□ Employment", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p1.16", "text_offset": 0, "text_span": 1 }, "reading_order": 0 } ], "reading_order": 15 }, { "id": "p1.17", "order": 19, "type": "text", "bbox": { "l": 82.32, "t": 325.68, "r": 547.92, "b": 312.72 }, "text": "2023", "reading_order": 16 }, { "id": "p1.18", "order": 20, "type": "text", "bbox": { "l": 83.28, "t": 303.36, "r": 548.64, "b": 288.72 }, "text": "□ Other ___", "children": [ { "id": "p1.18.1", "order": 21, "type": "form_field", "bbox": { "l": 83.28, "t": 303.36, "r": 95.28, "b": 291.36 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "□ Other ___", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p1.18", "text_offset": 0, "text_span": 1 }, "reading_order": 0 } ], "reading_order": 17 }, { "id": "p1.19", "order": 22, "type": "text", "bbox": { "l": 48.72, "t": 270.48, "r": 561.84, "b": 214.56 }, "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.", "reading_order": 18 }, { "id": "p1.20", "order": 23, "type": "text", "bbox": { "l": 49.44, "t": 192.48, "r": 558.48, "b": 180 }, "text": "Student Signature _____", "children": [ { "id": "p1.20.1", "order": 24, "type": "form_field", "bbox": { "l": 52.2, "t": 191.8099, "r": 557.1171, "b": 180.2899 }, "text": "", "attrs": { "field_kind": "text", "label": "Student Signature _____", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.20" }, "reading_order": 0 } ], "reading_order": 19 }, { "id": "p1.21", "order": 25, "type": "text", "bbox": { "l": 433.44, "t": 192.24, "r": 558.24, "b": 180 }, "text": "Date _____", "reading_order": 20 }, { "id": "p1.22", "order": 26, "type": "text", "bbox": { "l": 49.92, "t": 161.04, "r": 558.24, "b": 148.56 }, "text": "Parent Signature (if student is under 18 years of age) _____ Date _____", "children": [ { "id": "p1.22.1", "order": 27, "type": "form_field", "bbox": { "l": 52.1997, "t": 160.7002, "r": 557.1108, "b": 149.1802 }, "text": "", "attrs": { "field_kind": "text", 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