Disclosure Statement

Required for use in collecting social security numbers
See OAR 589-004-0400

Department of Community Colleges and Workforce Development
Revised, August 2003

On the intake form which initially requests the social security number for each student, the following statement shall appear just above the space for the number:

"Providing your social security number is voluntary. If you provide it, the college will use your social security number for keeping records, doing research, aggregate reporting, extending credit and collecting debts. Your social security number will not be given to the general public. If you choose not to provide your social security number, you will not be denied any rights as a student. Please read the statement (use one: "on the back of this form," or "attached to this form," or "on page xx of your class schedule"), which describes how your number will be used. Providing your social security number means that you consent to use of the number in the manner described."

On the back of the same form, or attached to it, or in the schedule of classes, the following statement shall appear:

OAR 589-004-0400 authorizes Blue Mountain Community College to ask you to provide your social security number. The number will be used by the college for reporting, research, and record keeping. Your number will also be provided by the college to the Oregon Community College Unified Reporting System (OCCURS), which is a group made up of all community colleges in Oregon, the State Department of Community Colleges and Workforce Development and the Oregon Community College Association. OCCURS gathers information about students and programs to meet state and federal reporting requirements. It also helps colleges plan, research, and develop programs. This information helps the colleges to support the progress of students and their success in the workplace and other education programs.

OCCURS or the college may provide your social security number to the following agencies or match it with records from the following systems:

State and federal law protects the privacy of your records. Your number will be used only for the purposes listed above.