MJSD Directory Data Opt-out Form
  Menasha Joint School District Board policy defines directory data as a student's name; address; telephone number; date and place of birth; photograph; major field of study; participation in officially-recognized activities and sports; height and weight, if a member of an athletic team; dates of attendance; date of graduation; or degrees and awards received; and name of school most recently previously attended.

State Statute, 118.125 Pupil Records, allows the release of student directory information to any person or party without the written consent of the parent/guardian or adult student. In accordance with Federal and State law, the Board shall release the names, addresses, and telephone listings of secondary students to a recruiting officer for any branch of the United States Armed Forces or an institution of higher education who requests such information.

If you do not want your student’s data included in directory data requests, complete the information below. This form will be in effect on the date it is received and will be valid indefinitely unless MJSD is notified in writing that the directory data can be released.

For the complete Board policy that includes Directory Information, please see Policy 8330 – Student Records. All Board policy may be found at www.mjsd.k12.wi.us, Board of Education, Board Policy.  
Adres e-mail *
Student's Legal Name *
Student's Date of Birth *
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Student's Current School *
Parent/Guardian Signature
Entering your name will be accepted as a signature. Invalid entries will void this form.
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