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505.2.4P - Request for Lists of Directory Information

505.2.4P - Request for Lists of Directory Information

Adopted:  February 1987
Revised:  January 2023

 

Download 505.2.4P - Request for Lists of Directory Information

 

This form is to be completed by persons requesting lists of student directory and yearbook information. This request and the required fee should be submitted to Student Information. As provided by law, military recruiting officers shall not be charged a fee. Any alteration of the lists is not permitted.

 

1.     Identifying Information to Facilitate Access to Data (please print)

 

____ Name__________________________________________________________________

 

____ Agency/business represented _________________________________________

 

____ Address/city/zip_______________________________________________________

 

____ Telephone number_____________________________________________________

____

____ Email address_________________________________________________________

 

2.     Request for Lists (indicate the quantity of each list you are requesting):

         (Note:  All lists are provided in alphabetical order. In accordance with state and federal law, addresses and home telephone numbers of high school students are only available as requested by military recruiting officers and institutions of higher education, see section C.)

 

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A.    Names of ALL students (kindergarten-grade 12, sorted by grade)                           

                                                                                                                                                              Total

                        o Electronic list @ $30 each                  $30 x _____ lists =  $_______

                        o Paper list @ $40 each                         $40 x _____ lists =  $_______

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B.    Names and school email addresses of students in grades 9-12 (check boxes to indicate requested lists)

                        

     Apple Valley High School:                o Seniors   o Juniors   o Sophomores o Freshmen

 

     Eagan High School:                           o Seniors   o Juniors   o Sophomores o Freshmen

 

     Eastview High School:                      o Seniors   o Juniors   o Sophomores o Freshmen

 

     Rosemount High School:                  o Seniors   o Juniors   o Sophomores o Freshmen

 

     School of Environmental Studies:  o Seniors   o Juniors

 

     Area Learning Center:                       o Seniors   o Juniors   o Sophomores o Freshmen

 

                                                                                                                           Total

                        o Electronic list @ $10 each                  $10 X _____ lists =  $_______

                        o Paper list @ $15 each                         $15 X _____ lists =  $_______

 

Procedure 505.2.4P

Page 2

 

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C.    Names, school email addresses, addresses and home telephone numbers of students in grades 9 11-12 (check boxes to indicate requested lists) (Note:  These lists are only available to military recruiting officers and institutions of higher education, and may not be shared with any other person or organization, may not be copied and may not be given to someone else to copy.)

 

     Apple Valley High School:                o Seniors   o Juniors   o Sophomores o Freshmen

 

     Eagan High School:                           o Seniors   o Juniors   o Sophomores o Freshmen

 

     Eastview High School:                      o Seniors   o Juniors   o Sophomores o Freshmen

 

     Rosemount High School:                  o Seniors   o Juniors   o Sophomores o Freshmen

 

     School of Environmental Studies:  o Seniors   o Juniors

 

     Area Learning Center:                       o Seniors   o Juniors   o Sophomores o Freshmen

 

                                                                                                                           Total

                        o Electronic list @ $30 each                  $30 X _____ lists =  $_______

                        o Paper list @ $40 each                         $40 X _____ lists =  $_______

 

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D.    GRAND TOTAL OF ALL LISTS                                                $_______

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3.  Submit payment (payable to Independent School District 196) with this           request to: 

Student Information
Independent School District 196

3455  153rd Street West
Rosemount, MN  55068-4946

                              FAX – 651-423-7787

 

Signature______________________________________________________ Date______________________________

 

OFFICE USE ONLY

 

Request:  Approved___   Denied___

 

                              ____________________________________________________________________         ________

                                                                               Student Information                                                     Date