FERPA Disclosure Log | UConn Privacy

Your Name(Required)

First Last

Your UConn Email(Required)

Are you reporting a breach or a purposeful disclosure of confidential student information?(Required)

Breach

Purposeful Disclosure

Student's Name(Required)

First Last

Student's ID Number(Required)

Information disclosed by:(Required)

The party/parties who have requested or received the information:(Required)

Student Information Disclosed(Required)

Select the [+] symbol to add rows for more than one type of record.

Reason for Disclosure(Required)

Date of Request(Required)

If reporting a data breach, this date should be the same as the date of disclosure.

Date of Disclosure(Required)

Name

This field is for validation purposes and should be left unchanged.