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Consent to Release Confidential Information

In accordance with the Family rights and Privacy Act (FERPA) of 1974, Linfield College must have written consent to release confidential student information to any entity outside the college, with the exception of directory information.  Completing this online form authorizes Linfield College to provide selected clinical sites and the Oregon State Board of Nursing your social security number, student identification number, date of birth and gender for the purpose of clinical placements and license preparation.  In addition, some clinical sites may request to review your clinical file for an accreditation audit.  Information is only shared on an as needed basis.  The information shared may include but is not limited to: clinical evaluations, background check documents, liability insurance information, health assessment forms, licensing information and/or current immunizations.  Questions about this form or FERPA may be directed to the Academic Records Specialist, Lindsey Bittner lbittne@linfield.edu.

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This form should be submitted by the first day of classes

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