Grade 11 ACT Non-Test Session Opt-in Form
The Arkansas Department of Education: Division of Elementary and Secondary Education (ADE:DESE) takes seriously its responsibility to protect the personal information of Arkansas students. In order to maintain the highest level of protection of personal information, it is the policy of the ADE:DESE that your child’s/ward’s personal information from the Grade 11 ACT State and District administration shall not be disseminated, including to colleges and universities, without your express consent. If you wish for your child's/ward's scores to be shared with colleges or universities based on the designation of recipients in the non-test session, please complete the form below. Failure to return this form does not prevent your child/ward from participating in the Grade 11 State and District administration of the ACT; it prevents his/her participation in the non-test session during which he/she would designate recipients of his/her scores. Additional score reports may be purchased
after scores are received by creating or signing in to the ACT web account or by contacting ACT Customer Care at (319) 337-1270. During the non-test session, examinees may also opt-in to the Educational Opportunity Service (EOS), which provides information from colleges, universities, financial aid/scholarship agencies, and organizations that offer educational programs.
Email address *
Parent/Guardian Name *
Student Name *
Student Date of Birth *
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Street Address, City/State/ ZIP *
Phone *
High School Student Attends
Signature Required for Students to Complete the Non-Test Portion of the ACT
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are "eligible students." Pursuant to Ark. Code Ann. § 6-18-109 (“The Student Online Personal Information Protection Act of 2015”), online services are restricted in the use of public school students’ personal identifiable information.

PLEASE READ THE FOLLOWING CAREFULLY:

TYPING MY NAME BELOW SERVES AS MY SIGNATURE GRANTING PERMISSION FOR MY CHILD'S/WARD'S GRADE 11 ACT SCORE TO BE SHARED WITH ANY INSTITUTION DESIGNATED DURING THE NON-TEST SESSION OF THE GRADE 11 ACT STATE AND DISTRICT ADMINISTRATION. I ALSO GRANT PERMISSION FOR MY CHILD/WARD TO OPT-IN TO THE EDUCATIONAL OPPORTUNITY SERVICE (EOS), WHICH PROVIDES FREE INFORMATION FROM COLLEGES, UNIVERSITIES, FINANCIAL AID/SCHOLARSHIP AGENCIES, AND ORGANIZATIONS THAT OFFER EDUCATIONAL PROGRAMS.
Parent/Guardian Name *
Date *
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YYYY
A copy of your responses will be emailed to the address you provided.
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