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JRA-E 2
CONSENT/DENIAL OF CONSENT TO RELEASE
STUDENT INFORMATION
(FOR ELEMENTARY AND MIDDLE SCHOOLS)
Federal law and regulations pertaining to family educational rights and privacy allow schools, without prior consent, to release at their discretion information from student educational records that has been designated by the school system as “directory information.” M.S.A.D. 71 has designated the following as directory information: student’s name, participation and grade level of students in recognized activities and sports, weight and height of student athletes, dates of attendance in the school unit, honors and awards received, and photographs and videos relating to school attendance and participation in school activities (except photographs and videos on the Internet).
Please check the box that applies and return this form to:
_________________________________
_________________________________
School Name
_________________________________
School Address
_________________________________
q I give my permission for ___________________________ School to release information about my son/daughter __________________________ that the school system has designated as “directory information.”
q I request that ________________________ School NOT release information of any kind, including “directory information,” concerning my son/daughter _______________________ without my prior written consent.
___________________________________ ________________________
Parent/Guardian Signature Date
Amended: 02/25/08