506.02.E1 Authorization for Releasing Student Directory Information

AUTHORIZATION FOR RELEASING STUDENT DIRECTORY INFORMATION

The Harlan Community School District has adopted a policy designed to assure parents and students the full implementation, protection and enjoyment of their rights under the Family Educational Rights and Privacy Act of 1974 (FERPA). A copy of the school district's policy is available for review in the office of the principal of all of our schools.

This law requires the school district to designate as "directory information" any personally identifiable information taken from a student's educational records prior to making such information available to the public.

The school district has designated the following information as directory information: student's name; date and place of birth; email address, grade level, enrollment status, major field of study; participation in officially recognized activities and sports; weight and height of members of athletic teams; dates of attendance; degrees and awards received; and the most recent previous educational institution attended by the student; student ID, user ID, or other unique personal identifier; photograph and other likeness and other similar information.

[Note: a district may, but does not have to, include all the information listed below, which is included in the United States Department of Education’s sample policy. This information should match the information contained in 506.1E8, 506.2R1, and 506.2E1].

· Student’s name

· Address

· Telephone listing

· Electronic mail address

· Photograph

· Date and place of birth

· Major field of study

· Dates of attendance

· Grade level

· Participation in officially recognized activities and sports

· Weight and height of members of athletic teams

· Degrees, honors, and awards received

· The most recent educational agency or institution attended

· Student ID number, user ID, or other unique personal identifier used to communicate in electronic systems that cannot be used to access education records without a PIN, password, etc. (A student’s SSN, in whole or in part, cannot be used for this purpose.)

You have the right to refuse the designation of any or all of the categories of personally identifiable information as directory information with respect to your student provided that you notify the school district in writing not later than the last day of the first week of the school year. If you desire to make such a refusal, please complete and return the slip attached to this notice.

If you have no objection to the use of student information, you do not need to take any action.

NOTE: If the board decides to eliminate name, address or telephone listing from their directory information, military recruiters and postsecondary institutions still have the right, under federal law, to access the three items. If the board eliminates name, address or telephone listing, the district needs to give parents a second notice allowing them to withhold this information from military recruiters or postsecondary institutions.

RETURN THIS FORM

Harlan Community School District

Parental Directions to Withhold Student/Directory Information for Education Purposes, for 20__-20__ School Year

Student Name: _____________________________________

Date of Birth: _________________________________

School: ___________________________________________

Grade: ______________________

Signature of Parent/Legal Guardian/Custodian of Child: _________________________________________

Date: _____________________________

This form must be returned to your child’s school no later than the last day of the first week of the school year.

Additional forms are available at your child’s school.

Parental Directions to Withhold Student Names, Addresses and Phone Numbers from Military Recruiters and Post-Secondary Educational Institutions, for 20__- 20__ school year.