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Application For Purchaser of Student Information
Application for Purchaser of Student Information
Requesting Organization
Organization (Requestor)
Address
Address
Address 2
City/Town
State/Province
- Select -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
ZIP/Postal Code
Name of Responsible Individual
Phone Number
Email
Information Request
Student information needed for which college?
- Select -
Chandler-Gilbert Community College
Estrella Mountain Community College
GateWay Community College
Glendale Community College
Mesa Community College
Paradise Valley Community College
Phoenix College
Rio Salado College
Scottsdale Community College
South Mountain Community College
Description of Information Requested
Date Needed
Is this request for commercial purposes?
Yes
No
Purpose of Request and Planned Use of Student Information
Policy/Conditions
All applicant/student information will be handled in accordance with requirements of appropriate rules, regulations, and legislations (e.g., the family Educational Rights and Privacy Act of 1974, also known as the Buckley Amendment; the Solomon Amendment of 1997, Arizona Open Records Act; etc.)
The affected MCCCD College will charge the requestor a fee for the information. The fee will include the portion of the cost to the state for obtaining the original...ARS 39-121.03. A fee will be assessed as allowed by law: $200 per thousand names for commercial purposes, $100 per thousand names for noncommercial purposes, and $75 per hour for programming time all to be paid upon receipt of information.
Requestor agrees not to sell, distribute, transfer, give or provide in any manner whatsoever the list to any other party or to a secondary market.
Requestor agrees that all solicitation materials forwarded to prospective, current, or former MCCCD college students will be truthful and accurate.
Requestor agrees not to present to any prospective, current or former students of the MCCCD College that the requestor is owned, operated, controlled by, related to, or affiliated with the affected MCCCD College and/or the State Community College Board in any manner.
Requestor agrees that its sole purpose in requesting the information is as stated in the written request to the designated individual at the affected MCCCD college.
While requests for student directory information are processed as soon as reasonably possible, it is likely that MCCCD College will provide the information to the requestor no sooner than (10) working days after receipt of written request and attachments from the requestor.
Requestor will be responsible for pick up or delivery of the information from the Office of Admissions and Records.
Questions should be directed to the Office of Admissions and Records at the specified MCCCD College.