FERPA CONSENT TO RELEASE STUDENT INFORMATION

I, the undersigned, hereby authorize President and Fellows of Harvard College (“Harvard University”), or an agent designated by Harvard University, to record, store and disclose audio and video recordings of Program sessions in which I am recorded (which may be subject to The Family Educational Rights and Privacy Act of 1974 and other applicable local privacy laws) to other Program participants for the sole purposes of Harvard’s internal educational use and Program participants’ educational use. I understand that this consent is optional, and that I have the right to revoke this authorization at any time by delivering a written revocation to Harvard University, but that such revocation will not affect any waiver of access to records obtained or received prior to delivery of such revocation. I understand that this consent shall also be understood to cover other applicable local privacy laws.

I have read and accept the terms of this Recording Authorization.