Consent Form Consent Form Consent Form to Allow Advisors to receive documents Please use this form to Consent to authorize Marshall University Title IX Office to share information directly with your Advisor.Information about YouYour Name(Required) First Last Student ID Number(Required)Provide your 901/903 NumberPreferred Name / Pronouns(Required)List your preferred name and pronouns.Preferred Method of ContactEmailPhoneYour Email Address(Required) Email Address Confirm Email Address Your Phone(Required)Consent InformationThe Family Educational Rights and Privacy Act (FERPA) protects student confidentiality by placing certain restrictions on the disclosure of information contained in a student’s education records. By signing this form, you agree that Marshall University personnel may provide information from your Title IX matter to your Advisor listed below. You further acknowledge that: (1) You have the right not to consent to the release of your Title IX records; and (2) this consent shall remain in effect until revoked by you, in writing, and delivered to Marshall University Title IX Office, but that any such revocation shall not affect disclosures made prior to the receipt of any such written revocation. You authorize Marshall University to release documents from the Title IX matter and/or any information contained therein to the Advisor listed below.Advisor First Name(Required)List Advisor's First NameAdvisor Last Name(Required)List Advisor's Last Name Your Name(Required) First Last Certify(Required) I hereby certified that my name is above and I am the student filling out this form, and my consent is true. By certifying this form, I agree that Marshall University personnel may provide information from my Title IX matter to mine Advisor listed above. I further acknowledge that: (1) I have the right not to consent to the release of my Title IX records; and (2) this consent shall remain in effect until revoked by me, in writing, and delivered to Marshall University Title IX Office, but that any such revocation shall not affect disclosures made prior to the receipt of any such written revocation. I authorize Marshall University to release documents from the Title IX matter and/or any information contained therein to the Advisor listed above.CAPTCHAThank you for taking the time to fill out the Consent Form.