{
    "document_id": 15745,
    "page": 1,
    "width_pt": 612,
    "height_pt": 792,
    "rotation": 0,
    "pipeline_version": "paddleocr-vl-1.6+paul-48",
    "engine": "paddleocr_vl",
    "source_run_id": 15855,
    "item_count": 27,
    "counts_by_type": {
        "figure": 1,
        "footer": 3,
        "form_field": 6,
        "heading": 1,
        "table": 1,
        "table_cell": 10,
        "text": 4,
        "title": 1
    },
    "build_ms": 2,
    "items": [
        {
            "id": "p1.1",
            "order": 1,
            "type": "title",
            "bbox": {
                "l": 70.08,
                "t": 744.96,
                "r": 562.56,
                "b": 719.04
            },
            "text": "Authorization to Release Directory Information",
            "attrs": {
                "block_label": "doc_title"
            },
            "level": 2
        },
        {
            "id": "p1.2",
            "order": 2,
            "type": "heading",
            "bbox": {
                "l": 69.12,
                "t": 691.44,
                "r": 184.56,
                "b": 675.12
            },
            "text": "KSU STUDENTS:",
            "level": 3
        },
        {
            "id": "p1.3",
            "order": 3,
            "type": "text",
            "bbox": {
                "l": 68.64,
                "t": 661.92,
                "r": 563.52,
                "b": 564
            },
            "text": "The Family Educational Rights and Privacy Act (FERPA) designates certain information as “directory information.” This applies to information such as name, address, phone number, date and place of birth, major field of study, participation in officially recognized activities and sports, weight/height (athletic teams), degrees and awards received, dates of attendance, and the most recent previous educational agency or institution attended. Under the provisions of the Family Educational Rights and Privacy Act, you have the right to withhold or release disclosure of such directory information."
        },
        {
            "id": "p1.4",
            "order": 4,
            "type": "text",
            "bbox": {
                "l": 68.88,
                "t": 551.52,
                "r": 537.84,
                "b": 522.24
            },
            "text": "Filling out this form will allow the University to release directory information to the public without your written consent."
        },
        {
            "id": "p1.5",
            "order": 5,
            "type": "text",
            "bbox": {
                "l": 68.64,
                "t": 509.76,
                "r": 544.8,
                "b": 465.84
            },
            "text": "By releasing the privacy restriction on your record, you allow the University to acknowledge your enrollment to anyone who requests verification of enrollment. This would include deferring loan repayments or inquiries from a prospective employer."
        },
        {
            "id": "p1.6",
            "order": 6,
            "type": "text",
            "bbox": {
                "l": 68.4,
                "t": 455.28,
                "r": 574.32,
                "b": 411.12
            },
            "text": "I have carefully read the above and request that “directory information” be disclosed to non-institutional persons or agencies by Kentucky State University without my written permission. I understand that authorization is applicable until such time as I request that it be withheld in writing."
        },
        {
            "id": "p1.7",
            "order": 7,
            "type": "table",
            "bbox": {
                "l": 62.16,
                "t": 387.12,
                "r": 564.48,
                "b": 129.12
            },
            "text": "",
            "attrs": {
                "block_label": "table",
                "n_rows": 5,
                "n_cols": 2,
                "integrity": {
                    "cells_checked": 7,
                    "cells_flagged": 1,
                    "flags": [
                        {
                            "row": 4,
                            "col": 0,
                            "coverage": 0.5,
                            "text": "Form Revised 2/ 2009"
                        }
                    ]
                }
            },
            "children": [
                {
                    "id": "p1.7.1",
                    "order": 8,
                    "type": "table_cell",
                    "bbox": {
                        "l": 72,
                        "t": 355.4761,
                        "r": 254.316,
                        "b": 344.6761
                    },
                    "text": "Student Printed Name (First MI Last)",
                    "attrs": {
                        "row": 0,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 1,
                        "bbox_refit": true,
                        "column_header": true,
                        "header_source": "heuristic"
                    },
                    "children": [
                        {
                            "id": "p1.7.1.1",
                            "order": 9,
                            "type": "form_field",
                            "bbox": {
                                "l": 72,
                                "t": 388.56,
                                "r": 312,
                                "b": 359.76
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Student Printed Name (First MI Last)",
                                "pdf_field_name": "Student Printed Name First MI Last",
                                "source": "acroform",
                                "row": 0,
                                "col": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "label_source": "parent_text",
                                "label_ref": "p1.7.1"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.7.2",
                    "order": 10,
                    "type": "table_cell",
                    "bbox": {
                        "l": 467.988,
                        "t": 355.4761,
                        "r": 490.6476,
                        "b": 344.6761
                    },
                    "text": "Date",
                    "attrs": {
                        "row": 0,
                        "col": 1,
                        "rowspan": 1,
                        "colspan": 1,
                        "bbox_refit": true,
                        "column_header": true,
                        "header_source": "heuristic"
                    },
                    "children": [
                        {
                            "id": "p1.7.2.1",
                            "order": 11,
                            "type": "form_field",
                            "bbox": {
                                "l": 393,
                                "t": 388.56,
                                "r": 561,
                                "b": 359.76
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "pdf_field_name": "Date",
                                "source": "acroform",
                                "row": 0,
                                "col": 1,
                                "rowspan": 1,
                                "colspan": 1,
                                "label": "Date",
                                "label_source": "parent_text",
                                "label_ref": "p1.7.2"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.7.3",
                    "order": 12,
                    "type": "table_cell",
                    "bbox": {
                        "l": 72,
                        "t": 300.2761,
                        "r": 157.65,
                        "b": 289.4761
                    },
                    "text": "Student Signature",
                    "attrs": {
                        "row": 1,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 1,
                        "bbox_refit": true
                    },
                    "children": [
                        {
                            "id": "p1.7.3.1",
                            "order": 13,
                            "type": "form_field",
                            "bbox": {
                                "l": 71.2603,
                                "t": 332.581,
                                "r": 312.641,
                                "b": 303.874
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "pdf_field_name": "Student Signature",
                                "source": "acroform",
                                "row": 1,
                                "col": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "label": "Student Signature",
                                "label_source": "parent_text",
                                "label_ref": "p1.7.3"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.7.4",
                    "order": 14,
                    "type": "table_cell",
                    "bbox": {
                        "l": 313.32,
                        "t": 335.52,
                        "r": 564.48,
                        "b": 283.92
                    },
                    "text": "",
                    "attrs": {
                        "row": 1,
                        "col": 1,
                        "rowspan": 1,
                        "colspan": 1
                    }
                },
                {
                    "id": "p1.7.5",
                    "order": 15,
                    "type": "table_cell",
                    "bbox": {
                        "l": 72,
                        "t": 245.0761,
                        "r": 156.318,
                        "b": 234.27610000000004
                    },
                    "text": "Student Birthdate",
                    "attrs": {
                        "row": 2,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 1,
                        "bbox_refit": true
                    },
                    "children": [
                        {
                            "id": "p1.7.5.1",
                            "order": 16,
                            "type": "form_field",
                            "bbox": {
                                "l": 72,
                                "t": 278.16,
                                "r": 312,
                                "b": 249.36
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "pdf_field_name": "Student Birthdate",
                                "source": "acroform",
                                "row": 2,
                                "col": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "label": "Student Birthdate",
                                "label_source": "parent_text",
                                "label_ref": "p1.7.5"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.7.6",
                    "order": 17,
                    "type": "table_cell",
                    "bbox": {
                        "l": 313.32,
                        "t": 283.92,
                        "r": 564.48,
                        "b": 232.32
                    },
                    "text": "",
                    "attrs": {
                        "row": 2,
                        "col": 1,
                        "rowspan": 1,
                        "colspan": 1
                    }
                },
                {
                    "id": "p1.7.7",
                    "order": 18,
                    "type": "table_cell",
                    "bbox": {
                        "l": 72,
                        "t": 189.87609999999995,
                        "r": 163.9464,
                        "b": 179.0761
                    },
                    "text": "Student ID number",
                    "attrs": {
                        "row": 3,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 1,
                        "bbox_refit": true
                    },
                    "children": [
                        {
                            "id": "p1.7.7.1",
                            "order": 19,
                            "type": "form_field",
                            "bbox": {
                                "l": 72,
                                "t": 222.96,
                                "r": 312,
                                "b": 194.16
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "pdf_field_name": "Student ID number",
                                "source": "acroform",
                                "row": 3,
                                "col": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "label": "Student ID number",
                                "label_source": "parent_text",
                                "label_ref": "p1.7.7"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.7.8",
                    "order": 20,
                    "type": "table_cell",
                    "bbox": {
                        "l": 395.964,
                        "t": 189.87609999999995,
                        "r": 457.6764,
                        "b": 179.0761
                    },
                    "text": "Student SSN",
                    "attrs": {
                        "row": 3,
                        "col": 1,
                        "rowspan": 1,
                        "colspan": 1,
                        "bbox_refit": true
                    },
                    "children": [
                        {
                            "id": "p1.7.8.1",
                            "order": 21,
                            "type": "form_field",
                            "bbox": {
                                "l": 393,
                                "t": 222.96,
                                "r": 561,
                                "b": 194.16
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "pdf_field_name": "Student SSN",
                                "source": "acroform",
                                "row": 3,
                                "col": 1,
                                "rowspan": 1,
                                "colspan": 1,
                                "label": "Student SSN",
                                "label_source": "parent_text",
                                "label_ref": "p1.7.8"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.7.9",
                    "order": 22,
                    "type": "table_cell",
                    "bbox": {
                        "l": 62.16,
                        "t": 180.72,
                        "r": 313.32,
                        "b": 129.12
                    },
                    "text": "Form Revised 2/ 2009",
                    "attrs": {
                        "row": 4,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 1
                    }
                },
                {
                    "id": "p1.7.10",
                    "order": 23,
                    "type": "table_cell",
                    "bbox": {
                        "l": 313.32,
                        "t": 180.72,
                        "r": 564.48,
                        "b": 129.12
                    },
                    "text": "",
                    "attrs": {
                        "row": 4,
                        "col": 1,
                        "rowspan": 1,
                        "colspan": 1
                    }
                }
            ]
        },
        {
            "id": "p1.8",
            "order": 24,
            "type": "figure",
            "bbox": {
                "l": 486,
                "t": 124.3801,
                "r": 567.4496,
                "b": 105.6
            },
            "text": "",
            "attrs": {
                "source": "pdf_image"
            }
        },
        {
            "id": "p1.9",
            "order": 25,
            "type": "footer",
            "bbox": {
                "l": 491.04,
                "t": 126,
                "r": 553.2,
                "b": 108
            },
            "text": "",
            "attrs": {
                "block_label": "footer_image"
            }
        },
        {
            "id": "p1.10",
            "order": 26,
            "type": "footer",
            "bbox": {
                "l": 260.16,
                "t": 105.84,
                "r": 315.6,
                "b": 96
            },
            "text": "WWW.KYSU.EDU",
            "attrs": {
                "block_label": "footer"
            }
        },
        {
            "id": "p1.11",
            "order": 27,
            "type": "footer",
            "bbox": {
                "l": 117.12,
                "t": 94.08,
                "r": 512.16,
                "b": 83.28
            },
            "text": "Kentucky State University is an equal educational and employment opportunity/affirmative action institution",
            "attrs": {
                "block_label": "footer"
            }
        }
    ],
    "excluded_furniture": {
        "first": [],
        "last": []
    }
}