FERPA and Confidentiality Agreement

Part One  (Please Print)

Employee Name:__________________________________________ W#: ___________
                             (Last)                          (First)              (Middle Initial)
                                                                                                
E-mail:_________________________________   WSU Extension:__________________

Does this person replace someone? (Y or N)___ If yes, who _______________________

Faculty __  Staff  __  Student __   Dept. ___________________  Cost Code:__________
             Department Access?  (Y or N)  ____      Continuing Ed. Access?  (Y or N) ______

Immediate Supervisor: ________________________________  Date:_______________
                                            (Signature Required)

Part Two  (Please Read and Sign Below)

1. For purposes of the Agreement, “confidential information” is defined as information 
    disclosed to me, accessed by me, or otherwise known to me as a consequence of my
    employment.  It includes but is not limited to information accessible through the Weber
    State University LYNX system.
2. Along with the right to access transcripts/confidential records of students at Weber
    State University (WSU) comes the responsibility to maintain the privacy rights of 
    students as outlined in the Family Educational Rights and Privacy Act (FERPA).  I agree
    to comply with FERPA by not disclosing personally identifiable information about students
    to unauthorized third parties without the written consent of the student, except as
    permitted by law or federal regulations.  I further agree to consult with my supervisor,
    the University Registrar, or University Legal Counsel if I am uncertain about the
    appropriate response.
3. During my employment and after the termination of my employment, I will hold
    confidential information of the University in trust and confidence, and will not use or
    disclose it or any embodiment thereof, directly or indirectly, except as may be necessary
    in the performance of my duties for the University.  I understand that unauthorized
    disclosure could be highly damaging to the University, its faculty, staff, students, donors,
    or others.
4. I will not remove materials containing confidential information from Weber State
    University, unless authorized to do so by my supervisor.  Any and all such materials are
    the property of the University.  Upon termination of any assignment or as requested by
    my supervisor, I will return all such materials and copies thereof.
5. I agree to safeguard personally-identifiable data, the official records in the custody of
    the University, and the means and conditions of custodial security, and I agree to keep
    such information and means secure and strictly confidential at all times, whether on or
    off duty.

I acknowledge that I fully understand that the intentional disclosure by me of confidential information to any unauthorized person could subject me to criminal and civil penalties imposed by law.  I further acknowledge that such willful or unauthorized disclosure also violates University policy and could constitute just cause for disciplinary action including termination of my employment regardless of whether criminal or civil penalties are imposed.  Violations by Student employees will be forwarded to the Dean of Students for disciplinary action.

Employee Name: _________________________________   Date:__________________
                                    (Please Print)

Employee Signature: ______________________________________________________