Fillable PARENTS AND STUDENTS OPT-OUT FORM FOR DISCLOSURE OF

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PARENTS AND STUDENTS OPT-OUT FORM FOR DISCLOSURE OF

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PARENTS’ AND STUDENTS’ OPT-OUT FORM
FOR DISCLOSURE OF PERSONAL INFORMATION TO MILITARY
IMPORTANT NOTICE TO BOULDER VALLEY HIGH SCHOOL STUDENTS AND THEIR
PARENTS/GUARDIANS ABOUT ACCESS TO STUDENT INFORMATION
According to the Federal No Child Left Behind Act of 2001:
“(1)…each local educational agency receiving assistance under this Act shall provide, on a request
made by military recruiters or an institution of higher education, access to secondary school students’
names, addresses, and telephone listings.
(2) CONSENT A secondary school student or the parent of the student may request that the student’s
name, address and telephone listing described in paragraph (1) not be released without prior written
consent, and the local educational agency or private school shall notify parents of the option to make a
request and shall comply with any request.” (20 U.S.C. § 7908)
Instruction to NOT release student information to recruiters
The No Child Left Behind Act REQUIRES that the school district provide student names, addresses, phone
numbers to recruiters from the US military and institutions of higher education UNLESS a parent or the student
request in writing that this information be withheld.
__________________________________ __________________________________
Full Name of Student Name of School
As a parent or legal guardian,
I request that you DO NOT release the name, address or phone number of the above student to any
Armed Forces recruiter or the US Department of Defense.
I request that you DO NOT release the name, address or phone number of the above student to any
institution of higher education.
As a student,
I request that you DO NOT release my name, address or phone number to any
Armed Forces recruiter or the US Department of Defense.
I request that you DO NOT release my name, address or phone number to any
institution of higher education.
_______________________________________ _______________________
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PARENTS AND STUDENTS OPT-OUT FORM FOR DISCLOSURE OF

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Completed 6 May 2022

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