Please keep a copy of this form for your records. Date by tamir13

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									Please keep a copy of this form for your records.                              Date submitted________

:

       Recognizing the challenges faced by military recruiters, the No Child Left Behind Law requires
high schools to provide to military recruiters, upon request, access to names, addresses, and phone
numbers of high school juniors and seniors. The law also requires that your child’s high school, upon
request, release the above stated information to colleges or other higher learning institutions.

       Additional information regarding this matter may be found in the Parent & Student Handbook on
page 31 and Ed Code 49073-Family Education Rights and Privacy Act (FERPA)-Release of Directory
Information.

        If you do not want the New Haven Unified School District to disclose this information without
your prior written consent, you must fill out the bottom portion of this form and return it to me no later
than (insert date). If we do not receive the form back by this date, we will release student information to
military and college recruiters upon request. If your child is over 18, he or she must sign the form.

            If you have any questions, please do not hesitate to call our school office.



PARENT REQUEST TO NOT RELEASE INFORMATION TO COLLEGES/MILITARY
RECRUITERS/PROSPECTIVE EMPLOYERS

Student’s Name___________________________ Grade Level:______ ID#____________ Date_______

Do not disclose my child’s name, address or telephone number to the following without my prior consent
(check all that apply):

                        Colleges and other higher education institution recruiters (including military academies)
                        United States Military Recruiter
                        Prospective employers

Parent/Guardian signature_______________________________________________________________

Student’s Signature (if 18 years old)_______________________________________________________
H:\McNamara\Forms\military.doc

								
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