Forms

Forms

Student Records Release

The Family Rights and Privacy Act of 1974 (FERPA) provides for the confidentiality of student educational records. Fairfield University may not disclose information in a student's educational record to anyone, without the permission of the student, unless disclosure is permitted by an exception set forth in FERPA, 20 U.S.C.A., Sec. 1232 et seq.

If a student would like to grant permission to Fairfield University officials to disclose and/or discuss contents contained in education records at Fairfield University they must complete and sign a release.

Please fill out the appropriate release form and bring it to the office responsible for maintaining the educational record(s) to be released.

Guest Registration

All guests must be registered with the University by a University student. After completing the Guest Registration form, you will receive an e-mail to confirm your guest has been registered. Please print the confirmation letter and have your guest carry it along with a proper photo identification while visiting campus.

It is the resident's responsibility to find housing for guests on floors of their guest's gender. Guests attending University events may be charged a fee to participate. Guests may not remain on campus for more than three (3) days and the University student is responsible for the guest's behavior as outlined in the Student Handbook.

Residence Life Incident Report

Sexual Misconduct Anonymous Reporting Form

  • This is an anonymous reporting form. The information provided in this form will be shared with the university's Title IX coordinator, Public Safety, and the Office of the Dean of Students. You are not required to provide your contact information. If you are in immediate danger or in need of medical attention, contact Public Safety at (203) 254-4090. If you would like to speak with one of our on-campus confidential resources, contact Counseling and Psychological Services at (203) 254-4000 x. 2146, or the Confidential Advisor Mary Ellen Spitzfaden (203) 254-4000 x. 2146.

Confidential Reporting Form

  • If you know of a potential crime that has occurred on campus, please report it. This system is monitored Monday through Friday from 8:30 a.m. to 4:30 p.m.
    For immediate service, call (203) 254-4090 or ext. 4090 - all phone calls can remain anonymous.
  • Form for Confidential Report

Death Notification

Requesting a Withdrawal

Voluntary Withdrawal: Students applying for a voluntary withdrawal (for non-medical reasons) must contact their appropriate Academic Dean's Office in writing and set up a meeting to facilitate the withdrawal process and to discuss any future plans to return to the University. The institutional refund policy applies.

College of Arts and Sciences, CNS 100, ext. 2221
Exploratory Academic Advising, Kelley Center, ext. 2222
Dolan School of Business, DSB 1125, ext. 3230
Egan School of Nursing & Health Studies, Egan School 102, ext. 4150
School of Engineering, BNW 167, ext. 4147

Medical Withdrawal: Students who wish to withdraw from Fairfield University for medical reasons may request and be considered for a medical withdrawal when extraordinary circumstances prevent that student from continuing with classes. Medical withdrawals cover both physical as well as mental health difficulties.  Students are expected to remain away for at least a full semester (fall or spring) after a medical withdrawal before seeking readmission, unless deemed otherwise by the director of the Health Center or Counseling and Psychological Services.  The institutional refund policy applies. All withdrawal policies are found in the Academic Course Catalogs.

To discuss withdrawing as a student for medical reasons, contact the Health Center (203) 254-4000, ext. 2241, Counseling & Psychological Services (203) 254-4000 ext. 2146, or the Office of the Dean of Students (203) 254-4211.

Requesting Readmission

Students requesting readmission following a medical withdrawal from Fairfield must complete a Post-Medical Withdrawal Readmission form

Get Out and Vote

All students are strongly encouraged to participate in the electoral process and exercise their right to vote. Full-time undergraduate students who live on campus or off campus in the town are eligible to register locally and vote. Students who choose not to register locally, and maintain voter registration in another state or municipality, are encouraged to check the deadlines and procedures for absentee ballots in that specific state or municipality. Undergraduate commuters, graduate students, and part-time students should register with their local municipality. Students can pick up voter registration forms from the Office of Student Engagement located on the Barone Campus Center Lower Level - Suite 094.

For more information, please visit Your Vote, Your Voice

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