Adopted: June 1980
Revised: July 2023
Download 505.2.4.3P - Denial of Release of Directory and Yearbook Information
The school district designates some information about your child as “directory information.” This means the information can be published or released to the public. Also, some additional information on secondary students is available to the military and institutions of higher learning. If you wish to limit the release of this information, you must complete this form.
INSTRUCTIONS: This form is to be completed by a student's parent or guardian or by an adult student (18 years of age or older), if the parent or guardian, or adult student, wishes to deny the release of some or all information. There are two parts to this form. The first part relates to general directory information. The second part relates to release of certain information to the military and institutions of higher learning.
Denial of release of DIRECTORY INFORMATION
Pursuant to the district's Public Notice of Directory and Yearbook Information (Procedure 505.3.2P, Public Notice - Directory and Yearbook Information), the following directory information may not be published or released without written consent.
Check each category of directory information listed below that you do not want published or released.
• *Student's name
• Date and place of birth
• Major field of study
• Participation and performance in officially recognized school activities and sports
• Weight and height of members of athletic teams
• Dates of attendance
• Enrollment status
• *District-issued email address
• Grade level
• Degrees, honors, diplomas and awards received
• Honor roll
• School of attendance
• The most recent previous educational agency or institution attended
• Photographs and other visual and audio representations for school-approved publications, yearbooks, newspapers, public presentations, student ID badges and publication on school-approved Internet pages
• *Student identification (ID) number, user ID, or other unique personal identifier used by the student for purposes of accessing or communicating in electronic systems or displayed on a student ID badge
• Release to law enforcement officers only: School schedule, daily attendance record and parent or guardian names, email addresses and telephone numbers
• Release to the Dakota County Library only: Home addresses and telephone numbers for purposes of issuing a library card
*A parent/guardian may not prevent the disclosure of a students name, identifier or district-issued email address in a class in which the student is enrolled or on a student ID badge.
Denial of release of INFORMATION TO THE MILITARY AND INSTITUTIONS OF HIGHER LEARNING
In accordance with the Minnesota Statute 13.01-13.09, Government Data Practices Act and Public Law 107-110 (No Child Left Behind Act of 2001), the district must release to military recruiting officers and institutions of higher learning the names, home addresses and telephone numbers of students in 11th and 12th grades within 60 days after the date of the request, unless parents or students refuse to release the information.
Check ALL the information listed below that you do not want released:
¨ 11th or 12th grade student’s home address and telephone number (denial for release to military recruiters only)
¨ 11th or 12th grade student’s home address and telephone number (denial for release to institutions of higher learning only)
I understand that, depending upon what information has been denied, my child(ren)/I (for student 18 or older) may be excluded from documents such as yearbooks, honor rolls, news releases regarding sports achievements, honors received, athletic contest programs, theater and fine arts programs, graduation programs, future class reunion mailings, etc. I understand that this denial of release of directory and yearbook information shall remain in effect until it has been modified or rescinded at my written request or by my child(ren) upon reaching age 18 or older.
Student #1
print LEGAL name date of birth grade school
legal address legal relationship to student
Student #2
print LEGAL name date of birth grade school
legal address legal relationship to student
Student #3
print LEGAL name date of birth grade school
legal address legal relationship to student
Student #4
print LEGAL name date of birth grade school
legal address legal relationship to student
Parent Information
Parent/guardian/or student (18 years of age or older) name (please print)
Parent or guardian address (street, city, zip code)
Signature Date
Complete both sides of this form.
Return completed form to the principal of your child’s school.
Principals please forward original form to Student Information, District Office.