JR-EB ©

EXHIBIT

STUDENT  RECORDS

DESIGNATION OF DIRECTORY INFORMATION

During the school year, District staff members may compile nonconfidential student directory information specified below.

According to state and federal law the below-designated directory information may be publicly released to educational, occupational or military recruiting representatives without your permission.  If the Governing Board permits the release of the below-designated directory information to persons or organizations who inform students of educational or occupational opportunities, by law the District is required to provide the same access on the same basis to official military recruiting representatives for the purpose of informing students of educational and occupational opportunities available to them, unless you request in writing that the school not release the student's information without your prior signed and dated written consent.  If you do not object to the release of any and all of the below-designated information in writing, then the District must provide military recruiters, upon request, directory information containing the student's names, addresses and telephone listings.

If you do not want any or all of the below-designated information about your son/daughter to be released to any person or organization without your prior signed and dated written consent, you must notify the District in writing by checking off any or all of the rejected information, signing the form at the bottom of this page, and returning it to the Superintendent, within two (2) weeks of receiving this form.  If the School District does not receive this notification from you within the prescribed time, it will be assumed that your permission is given to release your son's/daughter's designated directory information.

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TO:  Principal

I do not want any or all the information I have þ below concerning (student's name) _________________________________designated as directory information and released to any person or organization without my prior written consent:

◻ Name                                                   ◻ Address

◻ Telephone listing                                  ◻ Electronic mail address

◻ Date and place of birth                         ◻ Photograph

◻ Dates of attendance                            ◻ Grade level

◻ Honors and awards received               ◻ Major field of study

◻ Enrollment status (e.g., part time or full time)

◻ Participation in officially recognized activities and sports

◻ Weight and height of members of athletic teams

◻ Most recent educational agency or institution attended

___________________________________     ________________________
             (Parent/guardian signature)                                       (Date)