MILIATARY OPT OUT FORM “Every Student Succeeds Act”
As a student you have the right to request that your private information, such as your name, address and telephone number, not be released to military recruiters.
Email address *
SCHOOL Southmoreland High School
STUDENT NAME *
Your answer
DATE OF BIRTH *
MM
/
DD
/
YYYY
As a student, I am exercising the right to “opt-out” and request that my name, address and telephone number not be released to military recruiters.
As a parent/guardian, I am exercising the right to "opt-out” and request that my student’s name, address and telephone number not be release to military recruiters.
By checking this box, I am certifying as with a signature, that I am the student above and I am 18 years or older.
By checking this box, I am certifying as with a signature, that I am a parent/guardian of the above student.
“Every Student Succeeds Act” requires school districts to release student names, addresses, and phone numbers to military recruiters upon their requests. The law also requires the school district to notify you of your right to Opt-Out from this by requesting that the district not release your information to military recruiters. The completion and return of this form serves as your request to withhold your private information.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Southmoreland School district. Report Abuse - Terms of Service