Forms & Policies » Student Information Opt-Out Form

Student Information Opt-Out Form

Notice of Possible Disclosure of Certain Student Information

  

The purpose of this document is to notify parents/guardians that certain student information may be disclosed/published UNLESS the parents/guardians opt-out.

 

 

Dear Student/Parent or Guardian:

 

State law (603 CMR 23.07) permits the Everett Public Schools to release the following directory information without the consent of the eligible student or parent: a student's name, address, telephone listing, date and place of birth, major field of study, dates of attendance, weight and height of members of athletic teams, class, participation in officially recognized activities and sports, degrees, honors and awards, and post-high school plans.

 

PLEASE FILL OUT THE FORM BELOW AND RETURN IT TO YOUR STUDENT’S SCHOOL ONLY IF YOU DO NOT WANT INFORMATION SHARED.

 

 

My signature verifies that:

 

£     I DO NOT want information shared as stated above.


STUDENT’S NAME ____________________________________________________________________________

 

STUDENT'S SIGNATURE  _______________________________________________________________________
(If the student is 14 years old or older)

 

SCHOOL ___________________________________________________ GRADE__________ROOM # ___________

 

PARENT/GUARDIAN NAME (PRINT) ______________________________________________________________

 

PARENT/GUADIAN SIGNATURE _________________________________________________________________

 

 

Please sign and return to the Principal’s Office