Non-Disclosure Directory Information, Marketing and Communications

Non-Discloure Directory Information Form

Student Information

Student First Name *

Student Last Name *

Home Address *

Apartment Number

City *

State *

Zip *

Country *

Email *

Directory Permission — I request that my standard directory information be withheld from:

Permissions Withheld *

Media releases for the 2012-13 academic year
Standard campus directories for the 2012-13 academic year

Release *

I understand that my standard directory information may still be shared with school officials with legitimate educational interests.