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 firstname.lastname@example.org.
This form should be submitted by the first day of classes