Skip to main content

Loading...

Editing previous response:

Please fix the highlighted areas below before submitting.

Notice Concerning Release of Student Directory Information

Please complete the form below. Required fields marked with an asterisk *

IMPORTANT PLEASE READ!

The Family Educational Rights and Privacy Act (FERPA), is a Federal law that protects the privacy of student educational records. FERPA applies to all schools that receive funds under an applicable program of the U.S. Department of Education. This law requires that Centralia School District, with certain exceptions, obtain your written consent prior to the disclosure of personally identifiable information from your child's education records. However, Centralia School District may disclose appropriately designated "directory information" without written consent, unless you have advised the District to the contrary in accordance with District procedures. The primary purpose of "directory information" is to allow the Centralia School District to include this type of information from your child's education records in certain school publicatios or public records requests. 

FERPA authorizes Centralia School District to release student "directory information" for school-related purposes and/or public records requests without parental permission unless you notify your child's principal, in writing, by October 1 or within 10 days of enrollment, that you do not want such information disclosed to the those who request it. The district has defined directory information as:

STUDENT DIRECTORY INFORMATION

  • Student/Parent/Guardian name, grade, date of birth, email and/or physical address, telephone number(s)
  • Participation in officially recognized sports or activities
  • Weight and height of members of athletic teams
  • Degrees, honors, and awards received
  • Dates of attendance: current and historical
  • Schools previously attended and/or post high school career plans

Centralia School District

Request to Prevent Disclosure of Student Directory Information

If you do NOT want Centralia School District to release Directory Information about your child, please sign and return this form to your child's school by October 1 or within 10 days of enrollment after October 1. Please return one form for each child. 

Note: if releasing this information is acceptable to you, no action is required.

Directory Information Opt-Out

SCHOOL/DISTRICT USE: Please do NOT release my child's directory information for Centralia School District.

 

Signature of parent/legal guardian*
Signature Required

Sign this form

By pressing “Sign Form,” you are agreeing to signing this form electronically.
Signature *
Type to sign
Draw your signature
Date:

(Student may sign form if he/she is 18 or older)

Confirmation Email