STUDENT INFORMATION OPT OUT FORM
To withhold the release of student information from military recruiters
by Jeff Flott
September 02, 2009
Tri-Point School District #6J
STUDENT INFORMATION OPT OUT FORM
Dear Parent / Guardian of High School Junior or Senior:
Under the federal and state law, school districts are required to distribute lists of high school juniors and seniors with their names, addresses and telephone numbers to United States Armed Forces Recruiting Agencies and other authorized agencies as requested. However, the Family Educational Rights and Privacy Act and the No Child Left Behind Act mandate that parents be offered an option to withhold the release of this information each year. If you wish to withhold the release of your child’s name, address and telephone number, you must complete the form below and return it to the school. The request to withhold the student information is applicable only to the current school year.
OBJECTION TO RELEASE OF
DIRECTORY INFORMATION TO MILITARY RECRUITERS
To: (principal’s name) ________________________________
I request that _________________________________ [print student’s name] name, address, and telephone number not be released to military recruiters upon their request during this school year. I understand that once this form has been signed by either the student or a parent, only a parent may change it. The completion and return of this form serves as your request to withhold your private information.
Signature of Student ____________________________________________Date: _____________
Signature of Parent or Guardian ___________________________________Date:______________
