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RELEASE OF STUDENT DIRECTORY INFORMATION

The Urbandale 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 District’s policy is available for review in the office of the Board Secretary, the Superintendent, and of the principals of all of our schools.

This law requires the District to designate as “directory information” any personally identifiable information taken from a student’s educational records which it will make available to the public without the parents’ or students’ prior consent.

The District has designated the following information as directory information:  student’s name, address and telephone number; the parents’ names, addresses, email addresses, and telephone numbers; date and place of birth; grade level and fields of study; participation in officially recognized activities and sports; weight and height of members of athletic teams; dates of attendance and building attended in the District; degrees and awards received; the most recent previous educational institution attended by the student; photographs and other likenesses 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 District in writing not later than the start of the school year (or within 10 days of enrolling in the District if a student enters after the start of the school year).  You also have a right to request that the District not release the student's name, address and telephone number to military recruiters and/or post-secondary institutions.  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 directory information, you do not need to take any action.

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RETURN THIS FORM

Urbandale Community School District Parental Directions to Withhold Student Directory Information for _______ - _______ school year.

Student Name: _________________________________Date of Birth:_________________

School: ______________________________________Grade:_______________________

Do not make any directory information available: __________________________________

Do not make the following directory information available:___________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Do not make the student's name, address and telephone number available to military recruiters

_________________________________________________________________________

Do not make the student's name, address and telephone number available to post-secondary institutions _______________________________________________________________

___________________________________________________________________________
(Signature of Parent/Legal Guardian/Custodian of Student) (Date)

___________________________________________________________________________
(Signature of Student 18 years of age or older) (Date)

Additional forms are available at school.

Revised: January 28, 2008

URBANDALE COMMUNITY SCHOOL DISTRICT BOARD OF DIRECTORS

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