Confidential Information Form
-Please return this form only if you Do Not want the following information used in school-related publications
-Check all areas that you Do Not wish published
-Please submit this form for each individual student in a given household
-This form is based on Board of Education Policy #8940
-Confidential Information Requests remain on file; this form does not need to be filled out annually unless you are requesting a change in status
Student's Name:
Your answer
Student's School:
Your answer
Grade:
Your answer
Address:
Your answer
Phone:
Your answer
Parent/Guardian
Your answer
Parent/Guardian Email
Your answer
Today's Date
MM
/
DD
/
YYYY
Student/Family Information
Please check any of the following items you Do Not want shared in district publications
Information Uses
Please check where you would like to restrict publications
Armed Forces Recruiting Representatives (grades 9-12)
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