Code No. 5O6.2El
PARENTAL AUTHORIZATION FOR RELEASING STUDENT DIRECTORY INFORMATION
The Riverside Community School District has adopted a policy designed to assure parents and students the full implementation, protection and enjoyment of their rights under the Family Educational Rights and Privacy Act of 1974. A copy of the school district's policy is available for review in the office of the principal of all of our schools.
This law requires the school district to designate as "directory information" any personally identifiable information taken from a student's educational records prior to making such information available to the public.
The school district has designated the following information as directory information: student's name, address and telephone number; date and place of birth; major field of study, participation in officially recognized activities and sports; weight and height of members of athletic teams; dates of attendance, degrees and awards received; and the most recent previous educational institution attended by the student and other similar information. You have the right to refuse the designation of any or all of the categories of personally identifiable information as directory information with respect to your student provided that you notify the school district in writing not later than September 15, 20___ of this school year. If you desire to make such a refusal, please complete and return the slip attached to this notice.
If you have no objection to the use of student information for the educational purposes described here, you do not need to take any action.
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RETURN THIS FORM
Riverside Community School District
Parental Directions to Withhold Student/Directory Information for Education
Purposes, for 20___ -20___ school year.
Student Name: ___________________________________Date of Birth ______________
School: _________________________________________Grade: _____________________
_______________________________________________________ _____________________
(Signature of Parent/Legal Guardian/Custodian of Child) (Date)
This form must be returned to your child's school no later than _________, 20___. Additional forms are available at your child's school.