Request for FERPA Hold
Office of the Registrar
Duke University School of Medicine
Box 3878 Phone:(919) 684-2304
Durham, NC 27710Fax: (919) 684-4322
8 Searle Center Drive, Rm 0387email:
STUDENT INFORMATION (Please print/write neatly)Date:
Name:Unique ID:
Former/Maiden Name:Phone:
Signature:Email:
By signing this form, I am authorizing the Office of the Registrar to place a HOLD on those educational records, which may be deemed Directory Information, as noted in the following.
FERPA Hold on All Directory Information ______
Specifiy directory information to be withheld: ______
In accordance with the Family Education Rights and Privacy Act (FERPA), students are granted certain rights with respect to their education records. They are:
- The right to inspect her or his education records.
- The right to amend the contents of the education record to ensure that they are not inaccurate, misleading, or otherwise in violation of the student’s privacy or other rights.
- The right to file a complaint with the U.S.Department of Education concerning perceived failure on the part of the school to satisfy the requirements of FERPA.
FERPA also limits the disclosure of personally identifiable information to others without the student’s prior consent with the following exceptions:
Directory Information:
Certain categories of information are considered to be directory information and do not require the student’s prior written consent to be disclosed. However, the Medical School Registrar’s Office complies with a student’s request to withhold directory information if notice is submitted in writing during the first three weeks of each new academic year; such requests must be renewed annually. Students considering nondisclosure should be aware that negative repercussions may result when inquiries are made by prospective employers, educational institutions, or other interested parties. This is particularly important for graduating students whose final nondisclosure requests continue to be honored until rescinded by the student.
The following have been designated as directory information by the University: name, address, telephone listing, date and place of birth, photograph, major field of study, participation in officially recognized activities and sports, weight and height of members of athletic teams, dates of attendance, degrees and awards received, and most recent previous educational institution attended. Class schedule is considered as directory information in the School of Medicine. Some of this information will be made available as a student directory for use by fellow students, faculty, and School of Medicine staff. In addition, match results for residency placement will also be made available on the web.
Legitimate Interests:
Prior consent is not required for disclosure of education records to school officials of Duke University who have been determined to have legitimate educational interests, appropriate parties in connection with an emergency, and in response to a court order or subpoena.
The complete university policy regarding FERPA is located on the website:
SOM-FERPAJuly 19, 2001