Skip to Main Content

Apply Now to the University of Wyoming apply now

Consent and Waiver

CONSENT To Transfer Student Records through the Student Exchange Program
Western Interstate Commission for Higher Education
3035 Center Green Drive, Boulder, Colorado 80301 Tel: (303) 541-0214

PURPOSE FOR REQUESTING STUDENT SIGNATURE ON CONSENT AND WAIVER FORM: Public Law 93-380, the Federal Family Educational Rights and Privacy Act of 1974, requires all who hold custody of student records to insure protection of personally identifiable information. Administration of WICHE Student Exchange Program requires the exchange of educational information about student applicants in order to provide for consideration of enrollment and transfer of funds by the state in the case of admission by the school. In order to facilitate exchange of necessary documents, the student applicant is asked to sign a "Consent and Waiver" statement.Student willingness to sign a consent statement is not a requirement for participation in the program.DESCRIPTION OF USE OF PERSONAL RECORDS: The program collects and uses information concerning student eligibility for the program; admission; enrollment; academic progress; graduation and/or termination from the professional program; and payment of fees by the state through WICHE to the receiving school.This information is exchanged between and among the certifying office of the student's home state; the staff of the Student Exchange Program, Western Interstate Commission for Higher Education; and the professional school(s) to which the student makes application and is admitted. The WICHE Commissioners of the sponsoring state may also review applications to consider eligibility of student(s).Periodic accounting for the Student Exchange Program in the state and in the region may result in publication of reports which may contain the student's name, home address, year of enrollment, enrolling institution, and money spent by the state to support the student's effort to reach an educational objective.

NOTIFICATION CONCERNING STUDENT ACCESS TO PERSONAL RECORDS: Any student participant or applicant for participation in the Student Exchange Program has access to his/her personal records maintained as a part of the exchange activity. He/she may inspect and/or receive copies at a cost not to exceed the actual cost of reproduction.

Consent and Waiver


• I understand that it is necessary to process student records in order to carry out the purpose of the Student Exchange Program, providing access to educational opportunities for residents of the western states.
• I understand that the record-keeping process requires preparation, transmission, receipt, filing, and reporting of information appropriate to the effectiveness and continuity of the program.
• I hereby consent to the transfer of personally identifiable educational records between and among the participants in the Student Exchange Program of the Western Interstate Commission for Higher Education to include the following:
Information concerning student eligibility, acceptance, and educational attainment
Information concerning fees paid by the sending state through WICHE to the receiving school
Lists of applicants certified as eligible for support
Admissions reports, withdrawal reports, and annual reports for WICHE Exchange Students
Support Agreement forms and invoices
Special letters of inquiry and response as required to address questions and concerns identified by program participants
• I understand that the information referred to herein will be available only to Student Exchange Program staff members, designated institutional officials, and sending state officials as required to carry out their official duties.
• I further consent to the transfer of all or a portion of the above educational records to admissions officers and certifying officers as required to accommodate the needs of the Student Exchange Program provided that the officers receiving the information will not permit any other party to have access to such information without the express written consent of the undersigned.
• I hereby waive my right to receive specific notification of the transfer of such records. I understand that personally identifiable educational records will be used only to the extent necessary to carry out the purposes of the Student Exchange Program including reasonable research studies necessary to evaluate and improve the program. Any general research report of information that might prove harmful or embarrassing will be included only when anonymity is preserved. Use of the information will be permitted only when, in the judgment of the Student Exchange Program director or other designated staff member, the request for information is wholly consistent with my best interests and the purposes of the Student Exchange Program.
• I understand that a log will be maintained to identify access to my records which is permitted pursuant to law, and this information will be available to me upon appropriate request. A locked file will be maintained for the regular storage and protection of personal educational records.

 


wiche Vet Med Applicants Only:

CONSENT To Transfer Student Records through the Student Exchange Program

Western Interstate Commission for Higher Education

3035 Center Green Drive, Boulder, Colorado 80301  Tel: (303) 541-0214

PURPOSE FOR REQUESTING STUDENT SIGNATURE ON CONSENT AND WAIVER FORM:  Public Law 93-380, the Federal Family Educational Rights and Privacy Act of 1974, requires all who hold custody of student records to insure protection of personally identifiable information.  Administration of WICHE Student Exchange Program requires the exchange of educational information about student applicants in order to provide for consideration of enrollment and transfer of funds by the state in the case of admission by the school.  In order to facilitate exchange of necessary documents, the student applicant is asked to sign a "Consent and Waiver" statement.

Student willingness to sign a consent statement is not a requirement for participation in the program.

DESCRIPTION OF USE OF PERSONAL RECORDS:  The program collects and uses information concerning student eligibility for the program; admission; enrollment; academic progress; graduation and/or termination from the professional program; and payment of fees by the state through WICHE to the receiving school.  

This information is exchanged between and among the certifying office of the student's home state; the staff of the Student Exchange Program, Western Interstate Commission for Higher Education; and the professional school(s) to which the student makes application and is admitted.  The WICHE Commissioners of the sponsoring state may also review applications to consider eligibility of student(s).

Periodic accounting for the Student Exchange Program in the state and in the region may result in publication of reports which may contain the student's name, home address, year of enrollment, enrolling institution, and money spent by the state to support the student's effort to reach an educational objective.

NOTIFICATION CONCERNING STUDENT ACCESS TO PERSONAL RECORDS:  Any student participant or applicant for participation in the Student Exchange Program has access to his/her personal records maintained as a part of the exchange activity.  He/she may inspect and/or receive copies at a cost not to exceed the actual cost of reproduction.

 CONSENT AND WAIVER

  • I understand that it is necessary to process student records in order to carry out the purpose of the Student Exchange Program, providing access to educational opportunities for residents of the western states.

  • I understand that the record-keeping process requires preparation, transmission, receipt, filing, and reporting of information appropriate to the effectiveness and continuity of the program.

  • I hereby consent to the transfer of personally identifiable educational records between and among the participants in the Student Exchange Program of the Western Interstate Commission for Higher Education to include the following:

  Information concerning student eligibility, acceptance, and educational attainment

  Information concerning fees paid by the sending state through WICHE to the receiving school

  Lists of applicants certified as eligible for support

  Admissions reports, withdrawal reports, and annual reports for WICHE Exchange Students

  Support Agreement forms and invoices

  Special letters of inquiry and response as required to address questions and concerns identified by program participants

  • I understand that the information referred to herein will be available only to Student Exchange Program staff members, designated institutional officials, and sending state officials as required to carry out their official duties.

  • I further consent to the transfer of all or a portion of the above educational records to admissions officers and certifying officers as required to accommodate the needs of the Student Exchange Program provided that the officers receiving the information will not permit any other party to have access to such information without the express written consent of the undersigned.

  • I hereby waive my right to receive specific notification of the transfer of such records. I understand that personally identifiable educational records will be used only to the extent necessary to carry out the purposes of the Student Exchange Program including reasonable research studies necessary to evaluate and improve the program. Any general research report of information that might prove harmful or embarrassing will be included only when anonymity is preserved.  Use of the information will be permitted only when, in the judgment of the Student Exchange Program director or other designated staff member, the request for information is wholly consistent with my best interests and the purposes of the Student Exchange Program.

  • I understand that a log will be maintained to identify access to my records which is permitted pursuant to law, and this information will be available to me upon appropriate request. A locked file will be maintained for the regular storage and protection of personal educational records.

WICHE VETERINARY MEDICINE APPLICANTS STATEMENT OF INTENT

TO: Applicants – WICHE Support in Veterinary Medicine

FROM: State Certifying Officer

RE: Statement of Intent

Certification for eligibility of WICHE support at all cooperating veterinary medical programs is based on the understanding that you are committed to remain in the degree program from the time of your first enrollment until completion of the course of study. Therefore, we have been requested to secure the following signed statement from each certified veterinary medicine applicant:

As a certified WICHE applicant, I am aware that if the State of Wyoming undertakes payment of support fees to defray the cost of my veterinary medical education, I am, if admitted under the WICHE program, committed to pursue my studies in veterinary medicine as a supported WICHE exchange student without voluntary interruption until I have qualified for my degree.

 


 WWAMI AND WYDENT programs:

PURPOSE FOR REQUESTING STUDENT SIGNATURE ON CONSENT AND WAIVER FORM: Public Law 93-380, the Federal Family Educational Rights and Privacy Act of 1974, requires all who hold custody of student records to insure protection of personally identifiable information. Administration of the WWAMI and WYDENT Student Exchange Programs requires the exchange of educational information about student applicants in order to provide for consideration of enrollment and transfer of funds by the state in the case of admission by the school. In order to facilitate exchange of necessary documents, the student applicant is asked to sign a "Consent and Waiver" statement.

Student willingness to sign a consent statement is not a requirement for participation in the program.

DESCRIPTION OF USE OF PERSONAL RECORDS: The program collects and uses information concerning student eligibility for the program; admission; enrollment; academic progress; graduation and/or termination from the professional program; and payment of fees by the state through the WWAMI or WYDENT programs to the receiving school.

This information is exchanged between and among the certifying office of the student's home state; and the professional school(s) to which the student makes application and is admitted. The WWAMI and WYDENT Appeals Committees of the Univ. of Wyoming College of Health Sciences may also review applications to consider eligibility of student(s).

Periodic accounting for the Student Exchange Program in the state and in the region may result in publication of reports which may contain the student's name, home address, year of enrollment, enrolling institution, and money spent by the state to support the student's effort to reach an educational objective.

NOTIFICATION CONCERNING STUDENT ACCESS TO PERSONAL RECORDS: Any student participant or applicant for participation in the WWAMI or WYDENT program has access to his/her personal records maintained as a part of the exchange activity. He/she may inspect and/or receive copies at a cost not to exceed the actual cost of reproduction.

Consent and Waiver

• I understand that it is necessary to process student records in order to carry out the purpose of the WWAMI and WYDENT programs providing access to educational opportunities for residents of Wyoming.

• I understand that the record-keeping process requires preparation, transmission, receipt, filing, and reporting of information appropriate to the effectiveness and continuity of the program.

• I hereby consent to the transfer of personally identifiable educational records between and among the participants in the WWAMI and WYDENT programs:

Information concerning student eligibility, acceptance, and educational attainment

Information concerning fees paid by the sending state through WICHE to the receiving school

Lists of applicants certified as eligible for support

Admissions reports, withdrawal reports, and annual reports for WWAMI and WYDENT students

Support Agreement forms and invoices

Special letters of inquiry and response as required to address questions and concerns identified by program participants

• I understand that the information referred to herein will be available only to certifying office staff members, designated institutional officials, and sending state officials as required to carry out their official duties.

• I further consent to the transfer of all or a portion of the above educational records to admissions officers and certifying officers as required to accommodate the needs of the WWAMI and WYDENT programs provided that the officers receiving the information will not permit any other party to have access to such information without the express written consent of the undersigned.

• I hereby waive my right to receive specific notification of the transfer of such records. I understand that personally identifiable educational records will be used only to the extent necessary to carry out the purposes of the WWAMI and WYDENT programs including reasonable research studies necessary to evaluate and improve the programs. Any general research report of information that might prove harmful or embarrassing will be included only when anonymity is preserved. Use of the information will be permitted only when, in the judgment of the University of Wyoming College of Health Science Dean or other designated staff member, the request for information is wholly consistent with my best interests and the purposes of the WWAMI and WYDENT programs. >

• I understand that a log will be maintained to identify access to my records which is permitted pursuant to law, and this information will be available to me upon appropriate request. A locked file will be maintained for the regular storage and protection of personal educational records.

 


Schedule an Appointment

Contact Us

College of Health Sciences

Pre-Professional Health Advising

Health Sciences 110

University of Wyoming

Laramie, WY 82071

Phone: (307) 766-3878

Email: hsadvise@uwyo.edu

1000 E. University Ave. Laramie, WY 82071
UW Operators (307) 766-1121 | Contact Us | Download Adobe Reader

Accreditation | Virtual Tour | Emergency Preparedness | Employment at UW | Privacy Policy | Harassment & Discrimination | Accessibility Accessibility information icon