7:015-E1 Notification to Parents of Family Privacy Rights

Date:  ____________________

Re: Student Survey Participation

Dear Parents:

Your child will be asked to complete a survey as described below:

Survey description: ___________________________________________

Survey grade/participants: ___________________________

Anticipated Survey date(s): ___________________

Parents/guardians may request that their child not participate in surveys that concern one or more of the following eight areas:

1. Political affiliations or beliefs of the student or student’s parent/guardian;
2. Mental or psychological problems of the student or student’s family;
3. Sexual behavior or attitudes;
4. Illegal, anti-social, self-incriminating, or demeaning behavior;
5. Critical appraisals of others with whom the student has close family relationships;
6. Legally recognized privileged relationships, such as with lawyers, doctors, or ministers;
7. Religious practices, affiliations, or beliefs of the student or parents/guardians; or
8. Income other than as required by law to determine program eligibility.

The school will not penalize any student whose parent/guardian exercises this option. In addition, a parent/guardian may review surveys asking questions about the above areas as well as other instructional materials. School Board policy 7:15, Student and Family Privacy Rights, contains a more thorough explanation of these rights and may be obtained from the Building Principal.

Opt-Out Instructions (Note: This notice and opt-out right transfers from parents/guardians to any student who is 18 years old.)

If you do not want your child to participate in this activity, contact your child’s Building Principal no later than  ___________ . If we do not hear from you by this date, we will assume that you do not object to having your child participate in the surveys described above.

Request to Review

If you wish to review any survey instrument or instructional material, please submit your request to the Building Principal. You will be notified of the time and place where you may review these materials.

Building Principal contact information: ______________________________

Date Approved:    May 29, 2009