{"id":1070,"date":"2024-09-12T12:33:34","date_gmt":"2024-09-12T16:33:34","guid":{"rendered":"https:\/\/www.marshall.edu\/titleix\/?page_id=1070"},"modified":"2024-09-12T12:33:34","modified_gmt":"2024-09-12T16:33:34","slug":"consent-form","status":"publish","type":"page","link":"https:\/\/www.marshall.edu\/titleix\/consent-form\/","title":{"rendered":"Consent Form"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_9' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Consent Form<\/h2>\n                            <p class='gform_description'>Consent Form to Allow Advisors to receive documents<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_9'  action='\/titleix\/wp-json\/wp\/v2\/pages\/1070' data-formid='9' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_9_52\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_9_52'>Please use this form to Consent to authorize Marshall University Title IX Office to share information directly with your Advisor.<\/div><\/div><div id=\"field_9_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Information about You<\/h3><\/div><fieldset id=\"field_9_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_1'>\n                            \n                            <span id='input_9_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_9_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_9_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_9_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_9_18'>Student ID Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_9_18' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_18\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_9_18'>Provide your 901\/903 Number<\/div><\/div><div id=\"field_9_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_9_19'>Preferred Name \/ Pronouns<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_9_19' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_19\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_9_19'>List your preferred name and pronouns.<\/div><\/div><div id=\"field_9_11\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_11'>Preferred Method of Contact<\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_9_11' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Email' >Email<\/option><option value='Phone' >Phone<\/option><\/select><\/div><\/div><fieldset id=\"field_9_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_9_2_container'>\n                                <span id='input_9_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_9_2' class='gform-field-label gform-field-label--type-sub '>Email Address<\/label>\n                                    <input class='' type='email' name='input_2' id='input_9_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_9_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_9_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email Address<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_9_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_9_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_5'>Your Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_9_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" \/><\/div><\/div><div id=\"field_9_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Consent Information<\/h3><div class='gsection_description' id='gfield_description_9_8'>The Family Educational Rights and Privacy Act (FERPA) protects student confidentiality by placing certain restrictions on the disclosure of information contained in a student\u2019s education records. By signing this form, you agree that Marshall University personnel may provide information from your Title IX matter to your Advisor listed below. You further acknowledge that: (1) You have the right not to consent to the release of your Title IX records; and (2) this consent shall remain in effect until revoked by you, in writing, and delivered to Marshall University Title IX Office, but that any such revocation shall not affect disclosures made prior to the receipt of any such written revocation.\n\nYou authorize Marshall University to release documents from the Title IX matter and\/or any information contained therein to the Advisor listed below.<\/div><\/div><div id=\"field_9_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_9_53'>Advisor First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_9_53' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_53\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_9_53'>List Advisor's First Name<\/div><\/div><div id=\"field_9_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_9_55'>Advisor Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_9_55' type='text' value='' class='large'  aria-describedby=\"gfield_description_9_55\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_9_55'>List Advisor's Last Name\n<\/div><\/div><fieldset id=\"field_9_56\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_56'>\n                            \n                            <span id='input_9_56_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_9_56_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_56.3' id='input_9_56_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_9_56_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_9_56_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_56.6' id='input_9_56_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_9_48\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Certify<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_48.1' id='input_9_48_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_9_48_1' >I hereby certified that my name is above and I am the student filling out this form, and my consent is true. By certifying this  form, I agree that Marshall University personnel may provide information from my Title IX matter to mine  Advisor listed above. I further acknowledge that: (1) I  have the right not to consent to the release of my Title IX records; and (2) this consent shall remain in effect until revoked by me, in writing, and delivered to Marshall University Title IX Office, but that any such revocation shall not affect disclosures made prior to the receipt of any such written revocation.  I authorize Marshall University to release documents from the Title IX matter and\/or any information contained therein to the Advisor listed above.<\/label><input type='hidden' name='input_48.2' value='I hereby certified that my name is above and I am the student filling out this form, and my consent is true. By certifying this  form, I agree that Marshall University personnel may provide information from my Title IX matter to mine  Advisor listed above. I further acknowledge that: (1) I  have the right not to consent to the release of my Title IX records; and (2) this consent shall remain in effect until revoked by me, in writing, and delivered to Marshall University Title IX Office, but that any such revocation shall not affect disclosures made prior to the receipt of any such written revocation.  I authorize Marshall University to release documents from the Title IX matter and\/or any information contained therein to the Advisor listed above.' class='gform_hidden' \/><input type='hidden' name='input_48.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_9_49\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_49'>CAPTCHA<\/label><div id='input_9_49' class='ginput_container ginput_recaptcha' data-sitekey='6LcJtEQiAAAAAP_vuQ362iVBQS2x9xrCp_cm3msg'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><div id=\"field_9_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 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