I-SS Annual FERPA Notification and Opt-Out Form


ANNUAL FERPA NOTIFICATION AND OPT OUT FORM

Federal law requires that we obtain your written consent prior to the release of personally identifiable information from your child’s education records. However, Iredell-Statesville Schools may disclose appropriately designated “directory information” without written consent, unless you have advised your child’s school to the contrary in accordance with district policy. The primary purpose of directory information is to allow I-SS to include this type of information from your child’s education records in certain school and district publications. Examples include:

▪ A  playbill,  showing  your  student’s  role  in  a  drama  production;  

▪ The  annual  yearbook;  

▪ Honor  roll  or  other  recognition  lists;  

▪ Photo  and  caption  on  the  school’s  or  district’s  webpage  or  social  media  pages;  

▪ Graduation,  choir,  band,  programs;  and    

▪ Sports  activity  sheets/programs      Directory information, which is information that is generally not considered harmful or an invasion of privacy if released, can also be disclosed to outside organizations without a parent’s prior written consent. Outside organizations include, but are not limited to, companies that manufacture class rings or publish yearbooks. In addition, two federal laws require school districts receiving federal funding to provide military recruiters, upon request, with the following information—names, addresses, and telephone listings— unless parents have advised us they do not want their student’s information released without prior, written consent. Please note that group photos are not subject to this policy.

Print Student’s Full Name:______________________________________________________________

Student’s Current Grade Level & Teacher (Homeroom):______________________________________

School:_____________________________________________________________________________

Please check only one of the following boxes.

☐ I understand my child’s directory information (including name, photograph, and grade) can be used in school-

related materials, including playbills, programs, newsletters, awards ceremonies, etc.

☐ Do not release my child’s directory information. I understand that, by checking this box, my child’s

information will not be released or used in any school programs, awards or recognitions activities, honor roll lists, athletic program, or other special publications or activities. My child’s photo and name may be used in the school yearbook.

☐ Do not include my child’s name or photograph in the school yearbook and do not release my child’s

directory information. I understand that, by checking this box, my child’s information will not be released or used in any school programs, awards or recognitions activities, honor roll lists, athletic program, or other special publications or activities.

Parent’s Printed Name:_______________________________________________________________________

Parent’s Signature:__________________________________________ Date:___________________________

Rev. 08/13/13


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