# JRA-E2 - Denial of Consent to Release Student Information (Marshwood High School)

**JRA-E2 - Denial of Consent to Release Student Information**

**(Marshwood High School)**

Federal law and regulations pertaining to family educational rights and privacy allow schools, without prior consent, to release at their discretion information from student educational records that has been designated by the school system as “directory information.<span class="Apple-converted-space"> </span>**MSAD #35** has designated the following as directory information: name, participation and grade level of students in officially recognized activities and sports, height and weight of student athletes, dates of attendance in the school unit, honors and awards received, and photographs and videos relating to student participation in school activities open to the public (except photographs and videos on the Internet).

In addition, the “No Child Left Behind Act of 2001” contains provisions that require that the school unit provide student names, addresses and telephone numbers to military recruiters and institutions of higher learning when requested to do so, unless the student’s parent/guardian or student 18 years of age or older requests in writing that such information not be released.<span class="Apple-converted-space"> </span>

If you **DO NOT** want the information released, please complete the appropriate section of this form and return it to:  
  
***Principal, Marshwood High School, 260 Route 236, South Berwick, ME 03908***

<span style="text-decoration: underline;"><span class="s1">***FOR PARENTS OF STUDENTS UNDER THE AGE OF 18:***</span></span>*<span class="Apple-converted-space"> </span>*

I request that Marshwood High School<span class="Apple-converted-space"> </span>

\_\_\_ **NOT** release the name, address, or telephone number of my son/daughter \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ to any military recruiter or military recruiting organization without my prior written consent.

\_\_\_ **NOT** release the name, address, or telephone number of my son/daughter \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ to any institution of higher learning without my prior written consent.

\_\_\_ **NOT** release information of any kind, including “directory information,” concerning my son/daughter \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ without my prior written consent.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_<span class="Apple-converted-space"> </span>\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***Parent/Guardian Signature <span class="Apple-converted-space"> </span>Date***

<span class="s1">***FOR STUDENTS 18 YEARS OF AGE OR OLDER:***</span>

I request that Marshwood High School

\_\_\_ **NOT** release the name, address, or telephone number of my son/daughter \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ to any military recruiter or military recruiting organization without my prior written consent.

\_\_\_ **NOT** release the name, address, or telephone number of my son/daughter \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ to any institution of higher learning without my prior written consent.<span class="Apple-converted-space"> </span>

\_\_\_ **NOT** release information of any kind, including “directory information,” concerning my son/daughter \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ without my prior written consent.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ <span class="Apple-converted-space"> </span>\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***Student Signature <span class="Apple-converted-space"> </span>Date***

Policy revised: February 10, 2021