ࡱ> *,)[ u bjbj jjul~~~~~~~:::: Fnnnnnq q q $  ),~q # Nq q q , ~~nnA q ~n~n q   V@~~nb `ݗ:{   W0   ~~~~ Office of Registration and Records Credential Records 350 New Campus Drive Brockport, NY 14420 (585) 395-5390 Family Educational Rights and Privacy Act, 1974 Directions: Respond to the Family Educational Rights and Privacy Act, 1974 by completing sections A and B of this form. (Refer to credential packet folder for further information.) Section A 1. Indicate your choice for an open or closed file in the appropriate box. 2. Print and sign your name and enter the date in areas indicated. Section B 1. Indicate those organizations (if any) to which your credential should not be sent. Print and sign your name and enter the date in areas indicated. Section A  Right of Access to I, (print name) Educational Records have chosen to (check one)  read and/or obtain copies (open file)  not read and/or obtain copies (closed file) of letters of recommendation, evaluations, and related documents contained in my credential file at the State University of New York, College at Brockport. I understand that to change this access status I must do so in writing, and that it applies to documents placed in my file after the date this status change is made. Signature:  Date: Section B Permission to Release I, (print name Document to Employers  and Graduate Schools authorize Credential Services, Office of Registration and Records at the State University of New York College at Brockport to release the documents in my credential file to employers and/or Graduate schools. This permission applies to all organizations except the following:   I understand that in order to withdraw this permission I must do so in writing and that it applies only to those requests made after this revocation is signed. Signature ______________________________Date________________ #$78rtw_l|23`a; < > u 㯻CJOJQJmHnHu jCJOJQJUmHnHu#j5CJOJQJUmHnHuOJQJ CJOJQJ5CJOJQJOJQJ5CJOJQJ%$8Nc7_fv`u & F ^`^ $^`a$$a$ ^`$a$u -2`,-% ? $dN$`a$$a$^ ^`` $dN $ ; < + 7 t u ^`^$dN` $dN / =! " #@$@% i0@0 Normal_HmH sH tH <@< Heading 1$@&5CJOJQJR@R Heading 4$$@&^`a$5CJOJQJ<A@< Default Paragraph FontNC@N Body Text Indent$^a$ CJOJQJu$8Nc7_fv`u-2`,-%?$;<+7tw08 u  u  u 8@l  ( HH >   ">   "VB  C D"VB   C D"VB   C D"VB   C D"VB   C D"VB  C D"VB  C D"VB  C D" VB  C D" B S  ?2`<=u $p,4$4BPt6Pt +4 0*+4  0*4+44p,4p,4w7=`f:>be@C+-w33333333333 Kevin Day7\\WEBSERVER\DEE$\Inetpub\users\regrec\waiverrelease.docPatty6C:\WINDOWS\TEMP\AutoRecovery save of waiverrelease.asdPattyA:\waiverrelease.docPattyA:\waiverrelease00.docPatty1C:\WINDOWS\TEMP\AutoRecovery save of VUMPRG23.asdPatty!C:\WINDOWS\TEMP\waiverrelease.docPattyA:\waiverreleasefall00.docPattyA:\waiverreleasefall00.docKara:C:\srinivas\users\webgrp\registrar\forms\waiverrelease.dotuser$C:\registrar\forms\waiverrelease.dotY //x<.0;x  ^ `o(.HH^H`o(.HH^H`o(.Y 0/xw@tu`@UnknownG: Times New Roman5Symbol3& : Arial9GaramondM" Univers (W1)ArialC"Albertus (W1)"(h73kf[;f:KF& Y20d2"Office of Registration and Records Kevin DayuserOh+'0  ( D P \ ht|#Office of Registration and Recordssffi Kevin DayReeviwaiverrelease.dottiuserrre5erMicrosoft Word 9.0i@F#@H@C>@ &՜.+,0 hp  SUNY Brockport 2 #Office of Registration and Records Title  "#$%&'(+Root Entry F`4-1Table WordDocumentSummaryInformation(DocumentSummaryInformation8!CompObjjObjectPool`4`4  FMicrosoft Word Document MSWordDocWord.Document.89q