Grade 11 ACT Parental Consent to Release Student Information Form 2024
Glen Rose juniors will take the FREE ACT on Tuesday, February 27, 2024.
**Your student will be given a paper copy of this form. You may submit this one electronically or complete and return the paper copy.


If you DO want your child/ward to participate in the state and district administration of the Grade 11 ACT and complete the Pre-ACT activities which include sending scores to colleges, at no cost to you, this form must be completed and submitted to the Glen Rose School District.  


If you do want your child/ward to take the ACT but DO NOT want your child/ward to receive a college-reportable ACT score through this state and district administration no further action is necessary, and you may exit this form.


If you DO NOT WANT your child to take a college reportable ACT, please complete the GRADE 11 ACT REFUSAL FORM and submit it to Glen Rose School District.



Pursuant to Ark. Code. Ann. 6-18-109 et seq. ("The Student Online Personal Information Protection Act of 2015"), online services are restricted in the use of public school students' personal identifiable information. The Arkansas Department of Education takes seriously its responsibility to protect the personal information of Arkansas students. In order to maintain the highest level of protection of personal information kit is the policy of the Department that your child's /ward's personal information shall not be disseminated to the ACT's Educational Opportunity Service which students opt into during test registration and which is free of charge - if you, acting as parent/guardian, revoke consent on behalf of the child/ward.

PLEASE READ THE FOLLOWING CAREFULLY:

BY SIGNING BELOW, I AGREE WITH THE ACT EOS TERMS LISTED ABOVE AND I ALSO GRANT PERMISSION FOR MY CHILD'S/WARD'S GRADE 11 ACT SCORE TO BE SHARED WITH ANY INSTITION DESIGNATED.


Email *
Student Name (First and Last) *
Student Date of Birth (MM/DD/YYYY) *
MM
/
DD
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YYYY
Street Address *
City *
State *
Parent/Guardian Day Phone *
Parent/Guardian Night Phone *
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