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\title{FERPA Waiver: Written Homework}
\author{Math 23: Differential Equations\\ Fall 2021 \\ Anne Gelb and Yao Xiao}
\begin{document}

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By my signature, I relinquish my FERPA rights in the following context: My written homework for Math 23, Fall 2021, may be returned en masse with others in the class via the homework boxes in Kemeny Hall.  I understand that my homework score may be visible to others. If  I  choose  not  to  relinquish  my  FERPA  rights,  I  understand  that  I  will  have  to present my student ID (for example at my instructor's office) in order to receive my exams and homework sets. 


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Name (Print) : \hrulefill 


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Signature: \hrulefill


\end{document}