Consent/Denial of Consent to Release Student Information (ESS, HMS)

CODE: JRA-E2

Maine School Administrative District No. 31

CONSENT/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 educational records that has been designated by the school system as "directory information". The District has designated the following as directory information: student's name, participation in officially recognized activities and sports, weight and height of student athletes, grade level in school of participants in extracurricular activities, date of attendance at local school unit schools, and honors and awards received.

Please check the box that applies and return this form to:

Superintendent

23 Cross Street

Howland, Maine 04448

_______ I give my permission for___________________________________________School to release information about my

son/daughter__________________________________________ that the school system has designated as “directory

information.”

_______ I request that____________________School NOT release information of any kind, including “directory information,”

concerning my son/daughter__________________________________without my prior written consent.

Parent/Guardian Signature ______________________________________________ Date___________________________