[ { "page": 1, "items": [ { "page": 1, "type": "TITLE", "location": { "l": 186.48, "t": 650.64, "r": 424.56, "b": 636 }, "text": "Consent to Release Educational Records", "reading_order": 0, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 33.36, "t": 604.32, "r": 572.64, "b": 514.32 }, "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.", "reading_order": 1 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 46.08, "t": 620.88, "r": 168.744, "b": 592.08 }, "text": "Student Name", "field_kind": "text", "label": "Student Name", "pdf_field_name": "Student Name", "pdf_field_type": "Text", "reading_order": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 33.6, "t": 507.36, "r": 567.12, "b": 462 }, "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.", "reading_order": 3 }, { "page": 1, "type": "TEXT", "location": { "l": 33.12, "t": 454.8, "r": 575.76, "b": 439.68 }, "text": "Kentucky State University is authorized to release educational information to the following individuals:", "reading_order": 4 }, { "page": 1, "type": "TEXT", "location": { "l": 32.88, "t": 410.4, "r": 259.2, "b": 344 }, "text": "Name", "reading_order": 5 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 36, "t": 425.04, "r": 256.32, "b": 396.24 }, "text": "Name", "field_kind": "text", "label": "Name", "pdf_field_name": "Name", "pdf_field_type": "Text", "reading_order": 6 }, { "page": 1, "type": "TEXT", "location": { "l": 35.04, "t": 393.6, "r": 547.2, "b": 378.48 }, "text": "Relationship to Student", "reading_order": 7 }, { "page": 1, "type": "TEXT", "location": { "l": 320.88, "t": 409.92, "r": 547.92, "b": 358.28 }, "text": "Relationship to Student", "reading_order": 8 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 425.04, "r": 544.32, "b": 396.24 }, "text": "Relationship to Student", "field_kind": "text", "label": "Relationship to Student", "pdf_field_name": "Relationship to Student", "pdf_field_type": "Text", "reading_order": 9 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 36, "t": 372.36, "r": 256.32, "b": 343.56 }, "text": "Name", "field_kind": "text", "label": "Name", "pdf_field_name": "Name_2", "pdf_field_type": "Text", "reading_order": 10 }, { "page": 1, "type": "TEXT", "location": { "l": 32.88, "t": 344, "r": 259.2, "b": 277.6 }, "text": "Name", "reading_order": 11 }, { "page": 1, "type": "TEXT", "location": { "l": 320.88, "t": 358.28, "r": 547.92, "b": 306.64 }, "text": "Relationship to Student", "reading_order": 12 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 372.36, "r": 544.32, "b": 343.56 }, "text": "Relationship to Student", "field_kind": "text", "label": "Relationship to Student", "pdf_field_name": "Relationship to Student_2", "pdf_field_type": "Text", "reading_order": 13 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 36, "t": 319.68, "r": 256.32, "b": 290.88 }, "text": "Name", "field_kind": "text", "label": "Name", "pdf_field_name": "Name_3", "pdf_field_type": "Text", "reading_order": 14 }, { "page": 1, "type": "TEXT", "location": { "l": 34.56, "t": 303.84, "r": 546.48, "b": 288.48 }, "text": "_____", "reading_order": 15 }, { "page": 1, "type": "TEXT", "location": { "l": 320.88, "t": 306.64, "r": 547.92, "b": 255 }, "text": "Relationship to Student", "reading_order": 16 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 319.68, "r": 544.32, "b": 290.88 }, "text": "Relationship to Student", "field_kind": "text", "label": "Relationship to Student", "pdf_field_name": "Relationship to Student_3", "pdf_field_type": "Text", "reading_order": 17 }, { "page": 1, "type": "TEXT", "location": { "l": 32.88, "t": 277.6, "r": 259.2, "b": 211.2 }, "text": "Name", "reading_order": 18 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 36, "t": 244.2, "r": 256.32, "b": 215.4 }, "text": "undefined", "field_kind": "text", "label": "undefined", "pdf_field_name": "Date", "pdf_field_type": "Text", "reading_order": 19 }, { "page": 1, "type": "TEXT", "location": { "l": 320.88, "t": 255, "r": 547.92, "b": 203.36 }, "text": "Student Name", "reading_order": 20 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 244.2, "r": 544.32, "b": 215.4 }, "text": "Student Name", "field_kind": "text", "label": "Student Name", "pdf_field_name": "Student Name", "pdf_field_type": "Text", "reading_order": 21 }, { "page": 1, "type": "TEXT", "location": { "l": 34.32, "t": 205.2, "r": 256.56, "b": 189.36 }, "text": "Date", "reading_order": 22 }, { "page": 1, "type": "TEXT", "location": { "l": 320.88, "t": 203.36, "r": 547.92, "b": 151.72 }, "text": "Student Signature", "reading_order": 23 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 191.52, "r": 544.32, "b": 169.68 }, "text": "Student Name", "field_kind": "text", "label": "Student Name", "pdf_field_name": "Student Signature", "pdf_field_type": "Text", "reading_order": 24 }, { "page": 1, "type": "TEXT", "location": { "l": 320.88, "t": 151.72, "r": 547.92, "b": 100.08 }, "text": "Student CWID#", "reading_order": 25 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 145.68, "r": 544.32, "b": 123.84 }, "text": "Student Signature", "field_kind": "text", "label": "Student Signature", "pdf_field_name": "Student CWID", "pdf_field_type": "Text", "reading_order": 26 } ] } ]