This FERPA form is used in compliance with Ark. Code for processing vision and hearing exam on qualified Medicaid applicants.  Vision and hearing is required by law on all students in the grades of K, 1, 2, 4, 6, 8, and PreK (ages 4+).

No student will incur any cost.

Thank you in advance.

Mrs. Jamie Stacks
Wonderview School District Superintendent



In compliance with the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 123g; 34 CFR Part 99).  I give permission for my child's personally identifiable information/student education records to be disclosed to a Third Party Billing Agent for the purpose of billing Medicaid and/or private insurance.