Page 55 - 2016 Iowa Central Student Handbook
P. 55

Iowa Central Community College
         Nondisclosure of Directory Information Request

       Iowa  Central  Community  College  considers  the  following  information  directory
       information and will release this information to others, without the written consent of
       the student, unless the student asks that the information be withheld. If you choose
       to withhold your directory information, this nondisclosure form must be completed
       and submitted to the Student Records Office by the end of the first 10 class days of
       the term. Iowa Central Community College employees have access to this information
       when they have a legitimate educational interest even though the student has put a
       hold on the information to parties outside the college.
       This “Nondisclosure of Directory Information” will be in effect until the student
       requests in writing that it be revoked.
       Students requesting non-disclosure understand that their name will not appear in
       the graduation program, in sports bulletins, music & theater brochures, honor rolls,
       home town newspapers, etc. Also, information requested by employers and student
       loan companies will not be released for verifications.
       • Name     • Personal e-mail address   • Honors & Awards
       • Address   • Date of Birth     • Previous education institutions attended
       • Major    • Dates of attendance   • Participation in recognized activities and sports
       • Telephone  • Enrollment Status   • Wgt. & Hgt. of Athletic Team Members
       • Degrees

        Please Print

                 (Last Name)            (First Name)      (Middle Name)

                        (Signature of Student)                (Date)

                        (Student ID Number)

                         Submit this form to Student Records

                                                               Revised 7/26/2011
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