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| To: All parents |
School Year _____________
|
The items listed below are designated as "directory information" of [name of agency or school] and may be released for any purpose at the discretion of [name of agency or school]. [Cite state laws and regulations or local policies where applicable.] Under the provisions of the Family Educational Rights and Privacy Act of 1974, as amended, you have the right to withhold the release of any or all of the information listed below.
[Listed below are example of Directory Information]
Please consider very carefully your decision
to withhold any item of "directory information." Should you decide to inform
[name of agency or school] not to release any or all of the items listed
below, any future requests for such information from individuals or entities
not affiliated with the [name of agency or school] will be refused. Please
indicat here your request to withhold any or all of the above items:
If this form is not received in [name of
office] prior to [date], it will be assumed that the above information
may be released for the remainder of the current school year. A new form
for nonrelease must be completed each [term/semester/year].
| Parent's Name:
_________________________ |
Student's Name:
______________________________ |
| Signature: __________________________ | Date: ________________ |
1 Adopted from American Association of Collegiate Registrars and Admissions Officers, Guidelines for Postsecondary Institutions for Implementation of the Family Educational Rights and Privacy Act of 1974 as Amended, Revised Edition, 1995.
For questions about the content of this product, please contact
Lee
M. Hoffman.
