# JRA-E3 - Denial Of Consent To Release Student Information (For Elementary and Middle Schools)

**JRA-E3 - Denial Of Consent To Release Student Information**

**(For Elementary and Middle Schools)**

Federal law and regulations pertaining to family educational rights and privacy allow schools, without prior consent, to release at their discretion information from student education records that has been designated by the school system as “directory information.” MSAD #35 has designated the following as directory information:<span class="Apple-converted-space"> </span>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).

If you **DO NOT** want the information released, please complete this form and return it to your building principal.

\_\_\_ I request that<span class="Apple-converted-space"> </span>\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ School **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

Policy revised: February 10, 2021