Policy Details

5145.15 FORM Notification to Parents RE Release of Certain Information

5145.15
FORM


STUDENTS


NOTIFICATION TO PARENTS

Release of Certain Information

Under the "No Child Left Behind Act"

Date:__________________

Dear Parent/Guardian:

Pursuant to the federal "No Child Left Behind Act," P.L. 107-110 (Title Ix, Sec. 9528), the Litchfield Public School District must disclose to military recruiters and institutions of higher learning, upon request, the names, addresses and telephone numbers of high school students.

The district must also notify parents/guardians of their right and the right of their child to request that the District not release such information without prior written consent.

Parents/guardians wishing to exercise their option to withhold their consent to the release of the above information to military recruiters and institutions of higher learning must sign this form below and return it to the Building Principal by ___________________.

Date

Reservation of Consent for the Release of Certain Student

Information under the "No Child Left Behind Act"

Please do not release the name, address and telephone number of __________________________________________________________________________________

Name of Student

to military recruiters and institutions of higher learning.

_____________________________ ____________________________ _________________

Print Name of Student School Grade

_____________________________________ ________________________

Parent's/Guardian's Signature Date

Litchfield Board of Education

Form adopted: April 19, 2006


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