Directory Information Opt-Out Form

I understand that the Family Educational Rights and Privacy Act (FERPA), a federal law, allows Jackson Preparatory & Early College to disclose designated directory information to third parties. I am choosing to have some or all of my child’s directory information be withheld from this disclosure.

Please check the applicable statement below. If selecting the second option, please check the information you do not want to be shared:

I do not authorize JPEC to share any of the following checked directory information with anyone outside of the Academy, with the exception of the military

I do not authorize JPEC to share any of the following checked directory information with anyone outside of the Academy.

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Student Name

Telephone Number(s)

Parent Information (name, address, phone, email address, etc.)

Photograph

Video or electronic images

Date of birth

Place of birth

Home address

Email address

Weight/Height

Grade level

Most recent school or educational institution attended

Participation in officially recognized activities and sports

Awards and honors received

Clubs/Affilliations

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Student Name

Student Number

Student Grade

Parent/Guardian Name

Parent/Guardian Signature

Date