NOTIFICATION TO PARENTS
Release of Certain Information
Under the "No Child Left Behind Act"
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 ___________________.
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