Mott Community College Safe Water Pledge The Aspen Institute Aspen Prize for Community College Excellence Top 150 2019

e-Learning Consent Form

 e-Learning Address & Consent for Release of Information Form

The Family Education Rights and Privacy Act (FERPA) of 1974 with amendments, was established to protect the privacy of student education resources. Except as allowed and required by law, no personally identifiable information from a student's record should be disclosed to any third party (e.g., parent, spouse, other students) without prior written consent of the student. e-Learning students usually communicate with their instructor, the e-Learning Office and the college in ways other than face-to-face. The purpose of this form is to obtain permission from you to answer inquiries for you about the e-Learning course you indicate below over the telephone, by voice mail, answering machine, U.S. Mail, email or other methods of communication that could possibly be defined as or used by a third party. This form will be provided to your instructor and a copy kept in the e-Learning Office.












(home / cell)*

Enter "none" if you do not have a phone
(work)

Enter "none" if you do not wish calls at work

I hereby authorize my instructor and the e-Learning Office to communicate all relevant information with me for the above course / semester using the above information.

November 12, 2018

 

September 19, 2018
Mott Tree Logo