506.2E1 Authorization for Releasing Student Directory Information

Code No. 506.2E1

Authorization for Releasing Student Directory Information

The school district has designated the following information as directory information:

· Student's name

· Address

· Telephone listing

· Electronic mail address

· Photograph

· Date and place of birth

· Major field of study

· Dates of attendance

· Grade level

· Participation in officially recognized activities and sports

· Weight and height of members of athletic teams

· Degrees, honors, and awards received

· The most recent educational agency or institution attended

· Student ID number, user ID, or other unique personal identifier used to communicate in electronic systems that cannot be used to access education records without a PIN, password, etc. (A student's SSN, in whole or in part, cannot be used for this purpose.)

· 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 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, you do not need to take any action.

RETURN THIS FORM

Davis County Community School District Parental Directions to

Withhold Student/Directory Information for Educational Purposes for ____ - ______ 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 September 15 of each school year.

Additional forms are available at your child’s school.

Approved:

Reviewed:

Revised: May 17, 2021