Marshall University Title IX Office FERPA Release for Branches

Please use this form to consent to authorize Marshall University to release your educational records to Branches Domestic Violence Shelter.

The Family Educational Rights and Privacy Act (FERPA) protects student confidentiality by placing certain restrictions on the disclosure of information contained in a student’s education records. By signing this form, you agree that Marshall University personnel may provide information from your education records as indicated below. You further acknowledge that: (1) You have the right not to consent to the release of your education records; and (2) this consent shall remain in effect until revoked by you, in writing, and delivered to Marshall University, but that any such revocation shall not affect disclosures made prior to the receipt of any such written revocation.

I hereby authorize Marshall University to release personal information and written records to Branches Domestic Violence Shelter as listed above from my educational records related to the following: 1) Any Title IX or related student disciplinary proceeding for sexual, interpersonal, or other acts of violence; 2) Any criminal conviction for sexual, interpersonal, or other acts of violence; or 3) Any Title IX or student disciplinary proceeding for sexual, interpersonal, or other acts of violence that was pending when I left Marshall University. Additionally, I authorize Marshall University to conduct any other investigation(s) it deems necessary to comply with policies or any federal or state law. This authorization includes, but is not limited to, conducting a criminal background check.

I understand that: 1) I have the right to revoke this consent, in writing, at any time except to the extent that action has already been taken upon this release. 2) I will not be contacted after an inquiry is made or information is released by/to Marshall University, 3) I have completed this disclosure form myself, and I understand what it says and agree to its terms.