Fill - Free fillable Form 1: Miami-Dade County Public Schools Directory Information (Miami Dade College) PDF form

FM-6479E Rev. (07-14)

Miami-Dade County Public Schools

Directory Information Opt-Out Form

Miami-Dade County Public Schools (M-DCPS) generally protects a student’s personally identifiable information

from

disclosure without prior consent from parents or eligible students. However, unless the parent or eligible student

specifically states in writing that they do not want this information provided, M-DCPS is required to provide senior high

school students’ names, addresses, and telephone listings to military recruiters or institutions of higher education upon

their request.

Additionally, in a joint effort to increase the number of students applying for higher education financial aid, Miami-Dade

County Public Schools and the United States Department of Education (USDOE) are participating in a Free Application for

Federal Student Aid (FAFSA) Completion Project. Unless the parent or eligible student specifically states in writing that

they do not want student information provided, M-DCPS may provide student information to the USDOE for this

purpose. If you do not want your child’s information disclosed to any or all of these entities, check the space next to

each entity listed below to which you do not want your child’s information disclosed.

I DO NOT CONSENT TO DISCLOSURE of my child’s name, address, telephone listing, or birth date to the following (check

all that apply):

____ United States Military (Army, Navy, Air Force, Marines, Coast Guard, etc.)

____ Institutions of Higher Education

____ USDOE for FAFSA Completion Project

Student’s Name: ________________________________Date of Birth: _________________ID#: ____________________

I understand that by checking the spaces above and submitting this form to the person indicated below, M-DCPS will

restrict the disclosure of personally identifiable student information from my child’s educational records to the

entities that I have selected.

I further understand that if I do not complete and return this form, M-DCPS will release the information to the above-

mentioned entities upon request by the entity and has no further obligation to contact me on a case-by-case basis to

request my consent for the disclosure of directory information to these entities.

_____________________________________________

Parent/Guardian Name

_____________________________________________ _________________________

Signature Date

To prohibit disclosure to the above-listed entities, return this form to your child’s school within the next 30 days to:

The Family Educational Rights and Privacy Act (20 U.S.C. § 1232g; 34 C.F.R., Pt. 99) governs the confidentiality of student

educational records.

See 20 U.S.C. § 7908.

FOR REGISTRAR USE ONLY:

1 - USM 5- USM/FAFSA

2 - IHE 6 - IHE/FAFSA

3 - FAFSA 7- USM/IHE/FAFSA

4 – USM/IHE

Clear Form

SÓLO PARA EL USO DEL SECRETARIO DE REGISTROS:

1‐USM 5‐USM/FAFSA

2‐IHE  6‐IHE/FAFSA

3‐FAFSA 7‐USM/IHE/FAFSA

4–USM/IHE

EscuelasPúblicasdelCondadoMiami‐Dade



Formulario para darse de baja del directorio

LasEscuelasPúblicasdelCondadoMiami‐Dade(M‐DCPS)normalmenteprotegenlainformación

queapareceeneldirectorio

personalqueidentificaalestudianteparaquenosedivulguesinelconsentimientopreviodelospadresodelosestudiantes

elegibles.Sinembargo,anoserqueunodelospadresoelestudianteelegibleespecíficamentedeclareporescritoquenodesean

quesedivulguedichainformación,lasM‐DCPSestánobligadasaproporcionarlosnombres,direccionesylaslistasdeteléfonosde

losestudiantesquecursanelúltimoañodesecundaria,areclutadoresdelejércitooainstitucionesdeeducaciónsuperior,previa

solicitud

.

Además,enunesfuerzoconjuntoconelfindeincrementarelnúmerodeestudiantesquesolicitanayudafinancieraparala

educaciónsuperior,lasEscuelasPúblicasdelCondadoMiami‐DadeyelDepartamentodeEducacióndelosEstadosUnidos(United

StatesDepartmentofEducationoUSDOE,porsussiglaseninglés)estánparticipandoenunproyectoendondeelestudiantellena

todoslosañosunasolicitudquedeterminasuelegibilidadpararecibirayudafinanciera(FreeApplicationforFederalStudentAid

(FAFSA)CompletionProject).Anoserqueunodelospadresoelestudianteelegibleespecíficamentedeclareporescritoqueno

deseaquesedivulguelainformación,lasM‐DCPS,portalmotivo,puedendivulgarlainformacióndelestudiantealUSDOE.Siusted

nodeseaquelainformacióndesuhijosedivulgueacualquieradeestasentidades,porfavor,hagaunamarcaalladodecadaunade

lasentidadesqueustednodeseaquelainformacióndesuhijosedivulgue.

NODOYMICONSENTIMIENTOPARAQUESEDIVULGUEelnombredemihijo;ladirección,númerodeteléfono,fechade

nacimiento(hagaunamarcaalladodetodaslasqueapliquen):

____ FuerzasarmadasdelosEstadosUnidos(Army,Navy,AirForce,Marines,CoastGuard,etc.)



____ Institucionesdeeducaciónsuperior

____ ElproyectodeFAFSACompletionProjectdelaUSDOE



Nombredelestudiante:_____________________________Fechadenacimiento: __________NúmerodeID#:____________



Entiendo que al marcar los espacios que aparecen anteriormente y entregar este formulario a la persona que se indica a

continuación, las Escuelas Públicas del Condado Miami‐Dade limitarán la divulgación de la información del directorio que se

encuentraenelexpedienteeducacionaldemihijoalasentidadesqueyohayaseñalado.



Además entiendo, que si no lleno y devuelvo este formulario, las M‐DCPS  divulgarán, previa solicitud, la información a las

entidades que se mencionan anteriormente y las M‐DCPS no tienen ninguna otra obligación de comunicarse conmigo

individualmentenidepedirmiconsentimientoparadivulgarlainformaciónqueapareceeneldirectorioaestasentidades.

_____________________________________________

Nombredelpadre/madre/tutor/tutora

_____________________________________________ _________________________

FirmaFecha



Paraprohibirquesedivulguelainformaciónalasentidadesmencionadasanteriormente,devuelvaesteformularioalaescuelade

suhijoantesde30díasa:





TheFamilyEducationalRightsandPrivacyAct(20U.S.C.§1232g;34C.F.R.,Pt.99)rigelaconfidencialidaddelosexpedientes

educacionalesdelestudiante.

Véase20U.S.C.§7908.

FM‐6479SRev.(07‐14)



LekòlLetaMiami‐DadeCounty

Fòm Direktwa pou Pa Bay Enfòmasyon Pèsonèl

“Miami‐DadeCountyPublicSchools(M‐DCPS”(LekòlLetaMiami‐DadeCounty)jeneralmanpwotejeyonelèvkont

piblikasyonenfòmasyonkikaidantifyelpèsonèlman

,sanapwobasyondavansnanmenparanoubyenelèvkielijibyo.

Sepandan,amwenskeparanelèvkielijiblaespesifikmandialekrilipavleyobayenfòmasyonsaa,M‐DCPSoblijebay

mounkapfèrekritmanpoulameoubyenenstitisyonedikasyonsiperyènon,adrès,aktelefònelèvlekòlsegondèlèyo

mande.



Anplis,nanyonefòtètansanmpouogmantekantiteelèvkiapaplikepouèdfinansyepouedikasyonsiperyè,LekòlLeta

Miami‐DadeCountyak“UnitedStatesDepartmentofEducation(USDOE)”(DepatmanEdikasyonEtazini)appatisipenan

yonPwojèAkonplisman“FreeApplicationforFederalStudentAid(FAFSA)”(AplikasyonGratispouÈdFederalpouElèv).

Amwenskeparanelèvkielijiblaespesifikmandialekrilipavleyobayenfòmasyonsaa,M‐DCPSkabayUSDOE

enfòmasyonsouelèvlapoubisaa.Siwpavleyopibliyeenfòmasyonpititouabaynenpòtoubyentoutantitesayo,

tchekeespaskiakotechakantite oupavleyobayenfòmasyonpititoua.

MWENPAKONSANTIPOUYODEVWALEnon,adrès,telefònoubyendatnesanspititmwenanbaysakapsuivyo

(Tcheketoutsakiaplike):

____ LameEtazini(Army,Navy,AirForce,Marines,CoastGuard,etc.)



____ EnstitisyonedikasyonSiperyè

____ PwojèAkonplismanUSDOEpouFAFSA



NonElèvla:________________________________DatNesans:_________#Idantifikasyon________________________

Mwenkonprannlèmwentchekeespaskianwoyoeremètfòm saabaymounyoendikeanbaa,M‐DCPSapentèdi

piblikasyonenfòmasyonnandosyeedikasyonèlpititmwenan kikaidantifye lpèsonèlmanbayantite mwenchwazi

yo.



Mwen konprann tou si mwen pa ranpli e retounen fòm sa a, M‐DCPS ap pibliye enfòmasyon an bay antite yo

mansyoneanwoyoelipagenokennlòtobligasyonpoulkontaktempèsonèlmanpoumandemkonsantmanmwen

poupibliyedirektwaenfòmasyonpèsonèlbayantitesayo.



_____________________________________________

NonParan/Gadyen



_____________________________________________ _________________________

SiyatiDat



Pouentèdipiblikasyonbayantiteyoekrianwoyo,remètfòmsaananlekòlpititouananespas30joubay:





1

AkòsouDwaEdikasyonèlakViPriveFanmian(20U.S.C.§1232g;34C.F.R.,Pt.99)detèminekonfidansyalitedosye

edikasyonèlelèv.

Wè20U.S.C.§7908.

FM‐6479H‐CRev.(07‐14)



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