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Contact Information

Please include City and State
Can we share your email address with your donor? *
Please copy your scholarship name from your email

PERMISSION TO DISCLOSE INFORMATION FROM EDUCATIONAL RECORDS FOR SCHOLARSHIPS, PRIZES, AND OTHER AWARDS

In accordance with the Family Educational Rights and Privacy Act (FERPA), it is the policy of Goucher College to withhold disclosure of personally identifiable information from educational records unless the student has consented to disclosure or FERPA allows disclosure. Please consult the Campus Handbook under “Student Records and FERPA” for more detailed information.

By completing this form, you authorize Goucher College to disclose the following personally identifiable information to the donor whose gift created the scholarship, prize, or other award you are receiving:

  • your name,
  • your hometown, and
  • a brief biography based on the information sheet you provided to the college in connection with your award.

Your agreement to disclose such information is voluntary, and is not a condition of receiving the award. This authorization shall remain in effect until revoked by you. Revocation must be made in writing to Lauren Stachowiak, director of donor relations and stewardship, in the Office of Advancement at Goucher College.

I hereby authorize Goucher College to disclose the information described above to the donor of the scholarship, prize, or award I am receiving. *
I hereby authorize Goucher to use my statements in promotional or donor fundraising materials. I also consent to have Goucher contact me about my statements if needed. *
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