5145.15 Form 1 5145.15 Form 1NOTIFICATION TO PARENTS
Release of Certain Information
Under the "Every Student Succeeds Act"
_________________20__
Dear Parent/Guardian:
Pursuant to the federal "Every Student Succeeds Act," P.L. 114-98 (Title Ix, Sec. 8025), the _______________ School District must disclose to military recruiters and institutions of higher learning, upon request, the names, addresses and telephone listings of high school students.
The district must also notify parents/guardians of their right and the right of their child, if eighteen years of age or older, to request that the District not release such information without prior written consent.
Parents/guardians and eligible students 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 "Every Student Succeeds 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