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.

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: _______________________________________________________