South Dakota School of Mines and Technology
Request to Prevent Disclosure of Directory Information

   
Since this request is governed by FERPA (the Family Educational Rights and Privacy Act), we need your signature on the form and therefore it cannot be submitted electronically. Please press the print button, complete the printed form, and bring it to Registrar and Academic Services in O'Harra 201 or mail it to:

Registrar & Academic Services
South Dakota School of Mines & Technology
501 E Saint Joseph St
Rapid City SD 57701

If you have questions you can contact aesinfo@sdsmt.edu

The items listed below are designated as "Directory Information" and may be released for any purpose at the discretion of our university.

Directory information includes your name, local and permanent mailing address, telephone number, e-mail address, photograph (e.g., yearbook photo), date and place of birth, major field of study, dates of attendance (including graduation date ), grade level, enrollment status (e.g., undergraduate or graduate, full time or part time), participation in officially recognized activities and sports, weight and height of members of athletic teams, degree, honors and awards received, and the most recent education agency or institution attended (previous to SDSMT).

Under the provisions of the Family Educational Rights and Privacy Act of 1974, as amended, you have the right to withhold the disclosure of "Directory Information".

Please consider very carefully the consequences of any decision by you to withhold "Directory Information".  Should you decide to inform the institution not to release this information, any future requests for such information from non-institutional persons or organizations will be refused.  Information about you will not appear in the SDSM&T Directory or any other publication such as graduation bulletins, honors lists, press releases, or Deans List Announcements.

I request to prevent disclosure of my "Directory Information".

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Date Student ID or Date of Birth
 

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Student's Name Student's Signature