Boulder Valley School District
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KLMA-E

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KLMA-E

File: KLMA-E (pdf)
Adopted:  March 14, 2006
Revised: January 15, 2014

PARENTS’ AND STUDENTS’ OPT-OUT FORM FOR DISCLOSURE OF PERSONAL INFORMATION TO MILITARY

IMPORTANT NOTICE TO BOULDER VALLEY HIGH SCHOOL STUDENTS AND THEIR PARENTS/GUARDIANS ABOUT ACCESS TO STUDENT INFORMATION

According to the Federal No Child Left Behind Act of 2001:

“(1)…each local educational agency receiving assistance under this Act shall provide, on a request made by military recruiters or an institution of higher education, access to secondary school students’ names, addresses, and telephone listings.

(2) CONSENT  A secondary school student or the parent of the student may request that the student’s name, address and telephone listing described in paragraph (1) not be released without prior written consent, and the local educational agency or private school shall notify parents of the option to make a request and shall comply with any request.” 20 U.S.C. § 7908.

Instruction to NOT release student information to recruiters

The No Child Left Behind Act REQUIRES that the school district provide student names, addresses, phone numbers to recruiters from the US military and institutions of higher education UNLESS a parent or the student request in writing that this information be withheld.


__________________________________    __________________________________
Full Name of Student                                      Name of School

As a parent or legal guardian,

  • I request that you DO NOT release the name, address, or phone number of the above student to any Armed Forces recruiter or the US Department of Defense.
  • I request that you DO NOT release the name, address, or phone number of the above student to any institution of higher education.

    As a student,
     
  • I request that you DO NOT release my name, address, or phone number to any Armed Forces recruiter or the US Department of Defense.
  • I request that you DO NOT release my name, address, or phone number to any institution of higher education.


_____________________________________________    _______________________
Signature                                                                               Date

End of File: KLMA_E