Fraternity and Sorority Life Grade Release

Please fill out this form if you are interested in membership in a fraternity or sorority.
Name?
E Number (ETSU Student ID)
Cell Phone Number?
Email Address?
Where do you live?
What is your address while you are at ETSU?
I am authorizing my grades to be released to the following organization(s):
What year are you in college?
The Family Education Rights and Privacy Act (FERPA) prohibits the release of personally identifiable information from the students’ education records without their prior written authorization. Exceptions to this policy are limited to: 1) release of such information to a specific list of officials with a legitimate educational interest in the record, 2) the release of such information in response to a court order, health or safety emergency, or approved research project, or 3) the release of public directory information which has not been previously restricted by the student.

In order to comply with the Family Educational Rights and Privacy Act (Public Law 93-380) passed by the 93rd U.S. Congress, as amended November 19, 1974, it is necessary for each student with interest in accepting membership in a sorority or fraternity to consent to the release of his/her academic records. Records to be disclosed include the student's semester grade point average, cumulative grade point average, judicial records, and any other records deemed appropriate by the Office Fraternity and Sorority Life . Parties to whom the records may be disclosed: Chapter President, Chapter and/or Faculty Advisors, Scholarship Chairperson, (Inter)National Headquarters Staff, Regional Chapter Advisors/Volunteers, Chapter Executive Officers, Council Leadership, the Office of Fraternity and Sorority Life & Student Affairs Staff.

Further, by initialing and completing this form, I confirm authorization for the Office of Fraternity and Sorority Life to release my grades to the respective organization with which I choose to affiliate (should I choose to affiliate with one), with the Office of Fraternity and Sorority Life, with fraternity advisors, with regional fraternity representatives, and with national fraternity representatives for each academic term that I am enrolled at East Tennessee State University.
By clicking I agree below, I agree to release my academic records according to the descriptions outlined above.
By typing my name below, I agree with the above-described fraternity and sorority policy on academic records release.
The East Tennessee State University Hazing policy is defined as:

Any Intentional or reckless act, on or off institutional property, by one student, acting alone or with others, which is directed against any other student, that endangers the mental or physical health or safety of that student, or which induces or coerces a student to endanger his or her mental or physical health or safety, and includes treatment of a violent, abusive, shameful, insulting, or humiliating nature.  Such an action is prohibited when connected with initiation into, affiliation with or continuing membership in a group or organization and does not include participation in customary athletic events or similar competitions. 

No Student organization or individual shall engage in or condone any form of hazing.  Hazing activity which is in violation of any other institution or school regulations such as the misuse of alcohol, drugs, school property, etc.  is strictly forbidden. 

I have read the East Tennessee State University policy on hazing and and agree that I will not participate in any event or act that could be considered hazing.  If I am asked to participate in any event that could be considered hazing, I agree to report it to Student Organization Resource Center within 24 hours at either etsufsl@etsu.edu or via phone at 423-439-6837.
By clicking below, I acknowledge that I have read the statement above, and I agree to the anti-hazing provisions of the university and to the actions required of me by said statement. 
By typing my name below, I affirm that I have read the above statements and I agree to them.