Notice of Right to Remove Student Name

Because Millington Central High School receives federal funds under the “No Child Left Behind Act of 2001”, the school must upon request, provide to military recruiters, colleges and universities, access to names, addresses and telephone number listings of secondary students.

Parents and Guardians need to know that they have the right to request that their student’s name, address and telephone number not be released to a military recruiter without prior written notice. If you would like to make such a request, please complete the following request and return a copy to the school guidance department.Use a separate form for each student

Military Recruiters (please check one)

_____Do not release my secondary student’s information to military recruiters at any time.

____Do not release y secondary student’s information to military recruiters until you have first obtained my prior written parental consent before doing so.

(please check one)

___ Do not release my secondary student’s information to Colleges, Universities, or Institutions of Higher Learning at any time.

___Do not release my secondary student’s information to Universities, or Institutions of Higher Learning until you have first obtained my prior written parental consent before doing so

Name of student__________________________

Name of Parent/Guardian___________________

Parent signature __________________________ Date __________

Adult Student signature_____________________ Date __________