Consent to Disclose Information

I understand that under the Family Educatioaln Rights and Privacy Act of 1974 (FERPA), (name of your college/university) may not disclose personally identifiable information from my education record to third parties without my signed written consent. I also understand that I can revoke this consent at any time with a written and signed revocation.

For the purpose of furthering its efforts to assist me in finding employment,

I hereby authorize the director and staff of the career services office at (name of college/university) to disclose by mail, fax, Internet, e-mail, or any other means, my resume/credential file and any other information contained in its files that relates to me to any employing organization except the following:

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

I hereby authorize the director and staff of the career services office at (name of college/university) to disclose by mail, fax, e-mail, Internet, or any other means, my resume/credential file and any other information contained in its files that related to me only to the employing organizations listed below:

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

I authorize the director and staff of the career services office at (name of college/university) to disclose by mail, fax, e-mail, Internet, or any other means, my resume/credential file and any other files related to me to third-party recruiters who may, in turn, forward my resume to interested employers.

I authorize the director and staff of the career services office at (name of college/university) to include my resume into the office's data base and to transmit (electronically or otherwise) this information as part of the data base to employing organizations.

Signature_______________________________________

Date ___________________________________________

Revocation of Consent to Disclose Information

I revoke my consent to disclose my resume/credential file and any other information contained in the career services office files or data base.

Signature ______________________________________

Date __________________________________________