506.02E1 - Authorization for Releasing Student Directory Information

The Independence Community School District has adopted a policy designed to assure parents/guardians 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 online and at the school district administration office.

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
  • Grade level
  • Degrees, honors, and awards received
  • Participation in officially recognized activities and sports
  • Weight and height of members of athletic teams
  • Photograph

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 September 30th of this 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.

 

 

 

RETURN THIS FORM

 

Independence Community School District Parental/Guardian 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 September 30th of each school year.

Additional forms are available at your child's school.