UNIVERSITY OF CALIFORNIA, BERKELEY CAMPUS LIFE AND LEADERSHIP
BERKELEY • DAVIS • IRVINE • LOS ANGELES • MERCED • RIVERSIDE • SAN DIEGO • SAN FRANCISCO SANTA BARBARA • SANTA CRUZ
CENTER F OR STUDENT CONDUCT AND COMM UNITY STANDARDS 2 5 3 6 C H A N N I N G W A Y , B LD G . E, M C 2 4 3 2 B E R K E LE Y , C A LI F O R N I A 9 4 7 2 0 - 2 4 3 2 TE L 510.643.9069 FAX 510.643.3133
WAIVER OF CONFIDENTIALITY
I understand that I have the right to confidentiality and privacy with respect to my student disciplinary record(s) as defined by the Family Educational Rights And Privacy Act (FERPA) and/or relevant state law. With my signature below, I waive my right to confidentiality in order to allow UC Berkeley Center for Student Conduct and Community Standards staff to discuss details of my disciplinary case(s) with (name listed below):
____________________________ Name of Student ____________________________ Student’s Signature ____________ Case #
_______________________ Date _______________________ SID # _______________________ Conduct Officer
____________________________________ Information Released To:
_________________________________ Relation to Student
________________________________________________________________________ Contact Information For Above
C A M P U S L I F E A N D L E A D E R S H I P • 102 SPROUL HALL • BERKELEY, CA 94720-2430 D E A N O F S T U D E N T S • C A L C O R P S P U B LI C S E R V I C E C E N T E R • GENDER EQUITY RESOURCE CENTER • CENTER FOR STUDENT LEADERSHIP FRATERNITY & SORORITY AFFAIRS • STUDENT INVOLVEMENT • OFFICE OF STUDENT CONDUCT • ATTORNEY FOR STUDENTS