STATEMENT OF UNDERSTANDING
OF THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974, AS AMENDED
I understand that by virtue of my employment with
________________________ at Case Western Reserve University, I may have access
to records which contain individually identifiable information, the disclosure
of which is prohibited by the Family Educational Rights and Privacy Act of 1974
as Amended. I acknowledge that I fully
understand that the disclosure by me of this information to any unauthorized
person, could subject the University to sanctions imposed by the Secretary of
the United States Department of Health, Education and Welfare. I further acknowledge that such willful or
unauthorized disclosure also violates Case Western Reserve University's policy
and may constitute just cause for disciplinary action (including expulsion) and
termination of my employment.
| ______________ | ___________________________ | _____________________________ |
| Date | Employee's Name | Employee's Signature
|
| ______________ | ___________________________ | _____________________________ |
| Date | Supervisor's Name | Supervisor's Signature |
