University of South Carolina Office of the University Registrar Privacy Request
Name
Date Last
First
MIddle
Student Number (SSN) 1. Privacy Indicator for Directory Information Check only one of the Privacy Indicators in this section. If you choose more than one option, no Directory Information will be released and you will not be listed in the Student Directory (USC telephone book) or in the electronic directory. A. Do not release any Directory Information about me. B. Do not list me in the Student Directory (USC telephone book) or in the electronic directory. C. Do not release my local address (including directory e-mail address). D. Do not release my permanent address.
All changes will go into effect within one business day after receipt by the Office of the University Registrar. This privacy request WILL PREVENT my name from appearing in external honors, awards, commencement programs, news releases, etc. This privacy request WILL NOT prevent the Office of the University Registrar from releasing information to my parents if they provide evidence that I am their dependent. This privacy request WILL NOT prevent internal offices and/or agents of the University System from obtaining the above information. This privacy request WILL NOT prevent the Office of the University Registrar from releasing information to authorized financial aid agencies as permitted by the Federal Family Educational Rights and Privacy Act of 1974. This privacy request WILL NOT prevent the Office of the University Registrar from releasing information in response to a lawfully-issued court order or subpoena.
2. Address Protection Indicator Do not change my permanent address, parent/guardian address or off-campus local address without my written permission. 3. Remove Privacy Indicator or Address Protection Indicator Check appropriate option(s) to cancel previous request(s). Release any Directory Information as allowed by the Family Educational Rights and Privacy Act of 1974 and University policy. Allow my permanent address, parent/guardian address or off-campus local address to be changed without my written permission.
Student’s Signature
Date
Do Not Write Below This Line – Office of the University Registrar Use Only
Processed by
AS 175 (8/04)
Date