{ "document_id": 16833, "page": 4, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 16944, "item_count": 25, "counts_by_type": { "figure": 1, "table": 1, "table_cell": 10, "text": 12, "title": 1 }, "build_ms": 2, "items": [ { "id": "p4.1", "order": 1, "type": "figure", "bbox": { "l": 24.48, "t": 766.08, "r": 88.8, "b": 702 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" } }, { "id": "p4.2", "order": 2, "type": "title", "bbox": { "l": 101.28, "t": 741.36, "r": 515.28, "b": 696 }, "text": "Consent to Release Educational Records", "attrs": { "block_label": "doc_title" }, "level": 2 }, { "id": "p4.3", "order": 3, "type": "text", "bbox": { "l": 33.12, "t": 663.36, "r": 579.6, "b": 595.2 }, "text": "I, ___, understand that the Family Educational Rights and Privacy Act (FERPA) grants me certain rights concerning my education records. Notwithstanding these rights, I consent to the release of my educational records to my parent(s) or guardian(s) listed below for the purpose of keeping them informed about my education at Kentucky State University. I understand that education records include, but are not limited to, information about my academic standing, disciplinary issues, and financial obligations to the University." }, { "id": "p4.4", "order": 4, "type": "text", "bbox": { "l": 33.84, "t": 580.56, "r": 578.4, "b": 539.28 }, "text": "This consent will remain in effect until I graduate or withdraw from the University. I understand that I may submit a subsequent notification in writing directing the University to no longer release information to any or all of the individuals listed below." }, { "id": "p4.5", "order": 5, "type": "text", "bbox": { "l": 36.48, "t": 509.04, "r": 558.48, "b": 456.72 }, "text": "Kentucky State University is authorized to release educational information to the following individuals:\nName" }, { "id": "p4.6", "order": 6, "type": "table", "bbox": { "l": 278.4, "t": 467.52, "r": 567.12, "b": 176.90431999999998 }, "text": "", "attrs": { "block_label": "table", "n_rows": 7, "n_cols": 2, "integrity": { "cells_checked": 7, "cells_flagged": 0 } }, "children": [ { "id": "p4.6.1", "order": 7, "type": "table_cell", "bbox": { "l": 278.4, "t": 467.52, "r": 422.76, "b": 426.0686 }, "text": "", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p4.6.2", "order": 8, "type": "table_cell", "bbox": { "l": 341.09, "t": 453.41032, "r": 444.41336, "b": 443.47432 }, "text": "Relationship to Student", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p4.6.3", "order": 9, "type": "table_cell", "bbox": { "l": 278.4, "t": 426.0686, "r": 422.76, "b": 384.6171 }, "text": "", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p4.6.4", "order": 10, "type": "table_cell", "bbox": { "l": 341.09, "t": 413.81032, "r": 444.41336, "b": 403.87432 }, "text": "Relationship to Student", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p4.6.5", "order": 11, "type": "table_cell", "bbox": { "l": 278.4, "t": 384.6171, "r": 422.76, "b": 343.1657 }, "text": "", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1 } }, { "id": "p4.6.6", "order": 12, "type": "table_cell", "bbox": { "l": 341.09, "t": 374.21032, "r": 444.41336, "b": 364.27432 }, "text": "Relationship to Student", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p4.6.7", "order": 13, "type": "table_cell", "bbox": { "l": 280.61, "t": 304.47032, "r": 343.22888, "b": 294.53432 }, "text": "Student Name", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p4.6.8", "order": 14, "type": "table_cell", "bbox": { "l": 280.37, "t": 264.87032, "r": 358.85336, "b": 254.93431999999996 }, "text": "Student Signature", "attrs": { "row": 4, "col": 0, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p4.6.9", "order": 15, "type": "table_cell", "bbox": { "l": 280.13, "t": 225.27031999999997, "r": 374.64344, "b": 215.33432000000005 }, "text": "Student Date of Birth", "attrs": { "row": 5, "col": 0, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p4.6.10", "order": 16, "type": "table_cell", "bbox": { "l": 280.73, "t": 186.84032000000002, "r": 328.6436, "b": 176.90431999999998 }, "text": "Student ID", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 2, "bbox_refit": true } } ] }, { "id": "p4.7", "order": 17, "type": "text", "bbox": { "l": 36.72, "t": 455.04, "r": 448.56, "b": 441.84 }, "text": "Name Relationship to Student" }, { "id": "p4.8", "order": 18, "type": "text", "bbox": { "l": 36.96, "t": 431.52, "r": 563.76, "b": 416.4 }, "text": "Name ___" }, { "id": "p4.9", "order": 19, "type": "text", "bbox": { "l": 34.32, "t": 430.08, "r": 323.76, "b": 416.16 }, "text": "___" }, { "id": "p4.10", "order": 20, "type": "text", "bbox": { "l": 36.96, "t": 413.04, "r": 320.4, "b": 401.28 }, "text": "；" }, { "id": "p4.11", "order": 21, "type": "text", "bbox": { "l": 35.04, "t": 402.48, "r": 322.56, "b": 374.4 }, "text": "_" }, { "id": "p4.12", "order": 22, "type": "text", "bbox": { "l": 42.72, "t": 376.32, "r": 564.96, "b": 361.92 }, "text": "Name" }, { "id": "p4.13", "order": 23, "type": "text", "bbox": { "l": 36.72, "t": 318.24, "r": 258, "b": 306.96 }, "text": "___" }, { "id": "p4.14", "order": 24, "type": "text", "bbox": { "l": 36.72, "t": 306.24, "r": 62.16, "b": 294 }, "text": "Date" }, { "id": "p4.15", "order": 25, "type": "text", "bbox": { "l": 445.68, "t": 62.4, "r": 505.68, "b": 49.92 }, "text": "Rev. 2/17/16", "attrs": { "block_label": "number" } } ], "excluded_furniture": { "first": [], "last": [] } }