Request to Inspect/Review or Receive Records

To the student:

Pursuant to federal law, and institutional policy, you have the right to inspect and review your own education records. For more information, please see the Family Educational Rights and Privacy Act of 1974 (20 USC § 1232).

By submitting this form, you have alerted the Office of Student Affairs that you would like to inspect and review your disciplinary records. The Office of Student Affairs will comply with a request for access within a reasonable time, not to exceed 45 days. Arrangements shall be made for the student to read or receive a copy of his or her records. With your permission, we may send these records electronically to you in an encrypted PDF format or through our student conduct system (Maxient). [Electronic records will only be sent to the student’s Fitchburg State Email address.] Should your file contain audio recordings, you will be required to provide a CD/DVD or USB drive for it to be copied to or we will send it electronically to you. Please understand that your records may have certain information redacted pursuant to law.

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Involved Parties

Please enter your information below.

Only your information is required - do not add additional persons to this request. These requests are only accepted on an individual basis.

Name or Organization

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

Please indicate the case number associated with your request.(Required) This field is required.

Do you wish to receive a copy of your records electronically or in-person? [If for some reason your records cannot be released you will be contacted and a suitable date/time will be arranged for you to review the records.](Required)

Electronically In Person

This field is required.

If in-person, what is the best way to contact you when your records are ready? [If picking up your records in person you will be required to present positive proof of identity.] This field is required.

Please acknowledge that you have read and agree to the following statement by printing your name in the box below: I understand that this information is released to me in accordance with university policies, and state and federal laws governing the release of information, including but not limited to FERPA. Once I receive the information I am fully aware that it is my information to do with as I please, and understand that the Office of Student Conduct and Office of Student and Academic Life is not responsible for the way in which the information is used. Further, I understand that any retaliation towards the individuals submitting the report and/or other persons identified in the report will be grounds for an immediate interim restriction, which may include being trespassed from campus, and that disciplinary action may be pursued.(Required) This field is required.