Parental Notice of Privacy Letter for Parents of All Ninth through Twelfth Grade Students
Dear Parent:

Federal law requires Local Education Agencies (LEAs) provide names, addresses, and telephone numbers of 11th and 12th grade high school students to military recruiters and institutions of higher education that request this information, except where the parent opts out in writing that he/she does not consent to the release of this information.

If you do not consent to the disclosure of this information, you must fill out the following form and return it to your child’s school. If you choose not to return the form at this time, you may do so at any time during your child’s school career and the request for non-disclosure will be honored. For parents of 9th and 10th grade students, the opt-out form can be completed and saved in advance.

Please complete the form for each child wishing to opt-out.
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Email *
Opt-Out of Release of Student Information Form
Please complete the following if you do not consent to the release of your child’s information - name, address, and telephone number - to military recruiters and/or institutions of higher education that request this information.
Student's Last Name *
Student's First Name *
Please put the student's legal name.
Student's Official Class *
Parent / Guardian Name (Last, First) *
I am requesting that my child’s name, address, and telephone number NOT be shared with: (please check appropriate box) *
Please type your name to serve as your electronic signature for the above information. *
A copy of your responses will be emailed to the address you provided.
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