This form is intended for use by students who are in a credential program.

All student records at Cal Poly Humboldt are kept in accordance with the provisions of the Family Educational Rights and Privacy Act of 1974 (FERPA), as well as California State University (CSU) and campus policies. The campus is authorized under the Act to release student "directory information" to the general public, as defined in the university catalog. The university does not release any other student information to non-university persons, third-parties, or other organizations without your written permission.