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It is required by all students registered in the Department of Materials Science and Engineering that this form be completed and returned to the Academic Services Office in 108 Rhines Hall. If any of the information below changes, a new form must be completed.

Student Directory Permission

I give my permission for my name, email address, classification (1EG, 2EG, 9EG), and graduate student advisor, if applicable, to be released in the departmental student directory. This is the only information which will be included in the student directory.

Yes No

UFID
Last Name
First Name
Middle Initial
Local Address:
Local City, State, Zip Code
Home Phone
Cell Phone
Email	@ufl.edu
Emergency Contact Information
Name
Relationship
Address
City, State, Zip
Phone Number