Section 9528 of the No Child Left Behind Act of 2001 requires schools to release our family’s private information to military recruiters unless we “opt out” in writing.

_____As a student, I am exercising the right to “opt-out” and request that my own name, address and telephone number not be released to military recruiters.

_____As a parent, I am exercising the right to “opt-out” and request that you do not turn over the name, address and telephone number of the following student to military recruiters.

School_________________________________________________

Student Name___________________________________________

Signature of Student______________________________________

Signature of Parent_______________________________________

Date______________________

Federal public law 107-110, section 9528 of the ESEA, “No Child Left Behind Act” requires school districts to release student names, addresses, and phone numbers to military recruiters upon request. The law also requires the school district to notify students and parents of the right to Opt-Out from this by requesting that the district not release students information to military recruiters. This form is intended to serve as a request to withhold this information.