Policy Details

5145.14 FORM Access to Student Information by Military College

5145.14
FORM

STUDENTS


ACCESS TO STUDENT INFORMATION BY MILITARY COLLEGE RECRUITERS

Name of Student: ________________________________ Date: _________________________

Name of Parent: _________________________________ School: ________________________

Dear Parent/Guardian and Secondary Students:

The Litchfield Public School District receives funds from the federal government under the No Child Left Behind Act of 2001. These funds are used in a variety of ways to provide additional help to students in greatest academic need. The law also requires that districts receiving these funds must, upon request, provide to military recruiters, colleges and universities, access to the names, addresses and telephone listings of secondary students.

It is important for you to know that a secondary school student or his/her parent or guardian may request that the student's name, address, and telephone number not be released by the District without prior written parental consent. If you would like to make such a request, please complete the following and return it to your child's school.

_______________________________________________________________________________

Parent or Guardian: Please complete this section and return the entire form to your child's school. Use a separate form for each child.

I am aware the Litchfield Public School District must provide access to military recruiters and colleges or universities of student names, addresses and telephone listings. I am aware the District will provide this information upon request, unless I require that such information not be given to the following groups without prior written parental consent:

Military Recruiters (please check one)

Do not release my secondary student's information to military recruiters at any time.

Do not release my secondary student's information to military recruiters until you have first obtained my prior written parental consent before doing so.

Colleges, Universities, or Institutions of Higher Learning (please check one)

Do not release my secondary student's information to colleges, universities or other institutions of higher learning at any time.

Do not release my secondary student's information to colleges, universities or institutions of higher learning until you have first obtained my prior written parental consent before doing so.

Parent Signature: ____________________________________ Date ____________________

Adult Student Signature: ______________________________ Date ____________________

Litchfield Board of Education

Form adopted: April 19, 2006

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