DIRECTIVE REGARDING DIRECTORY INFORMATION
Under the University's Fair Information Practices Regulations, I have the right to
request that certain personal information, which is regarded by the University as
"Directory Information," not be disseminated to other than University personnel or
where required by statute, court order, or legitimate University purpose.
I hereby direct that the following information regarding me not be disseminated
as "Directory Information":
(Please check each area to be restricted)
__________Home Address __________Social Security Number
__________Home Telephone Number __________Marital Status
__________Date and Place of Birth __________Citizenship
DATE_______________ PRINTED NAME_____________________________________
EMPLOYEE ID__________________ SIGNATURE________________________________________
Please complete and return this form to the Human Resources Information Center,
3rd floor, Whitmore Administration Building even if you do not desire to restrict
any category of information.