DISCLOSURE OF DIRECTORY INFORMATION

The University of North Carolina at Charlotte, in accordance with the Family Educational Rights and Privacy Act (FERPA), has designated the following information about students as public (directory) information:

• Student's name, local and permanent address, telephone number, email address, date and place of birth, class, major field of study, dates of attendance, enrollment status, degrees and awards (including scholarships) received, participation in officially recognized activities and sports, weight and height of members of an athletic team, and the most recent previous eduational agency or institution attended.

Under the provisions of the Act, you have the right to withhold the disclosure of "directory information" by notifying the Registrar’s Office in writing. The University will honor a request for non-disclosure until the student releases the University to allow disclosure of "directory information."

Please consider carefully the consequences of your decision to withhold any category of "directory information." The University receives many inquiries for "directory information" from a variety of sources including prospective employers, other institutions of higher education, honor societies, University commencement program, licensing agencies, government agencies, and insurance companies. This information will also be printed on our web site.  We will honor your request to withhold any information but cannot assume the responsibility to contact you for subsequent permission to release them. Regardless of the effect upon you, UNC Charlotte assumes no liability for honoring your instructions that information be withheld.

Please mark the appropriate boxes and affix your signature below to indicate your intention for UNC Charlotte to withhold the following public or directory information.  Once the form is submitted, restrictions will remain in effect indefinitely until the student releases the Unversity to allow disclosure of "directory information."  This includes Internet and verbal verification. Otherwise, it will be assumed that directory information may be disclosed for the remainder of the semester. Restriction may be released only with student’s signature.

[ ] WITHHOLD	Please withhold Directory Information
[ ] RELEASE	Please release the Directory Information hold currently on my records.

NAME:__________________________________ STUDENT ID _____________________
                                                    (Please Print)
SIGNATURE: ____________________________DATE: ____________________________

EMAIL: ____________________________

Return this form to:  Registrar's Office, 9201 University City Blvd., Charlotte, NC  28223
Fax:   (704) 687-3340