FERPA Directory Information Opt-Out Form

“Directory Information” means information contained in an educational record of a student that would not generally be considered harmful or an invasion of privacy if disclosed. FERPA permits LTS to designate certain personal information as “directory information,” which may be released to anyone who follows the procedures for requesting it as proscribed in school policy.

To prohibit LTS from releasing your student’s directory information, you must circle NO adjacent to the appropriate statement(s) below, sign the form, and return it to your student’s school. Completion of this form is optional. However, if you do not circle NO or return this form, directory information about your student may be released in accordance with LTS policy.

If you have more than one student enrolled, you must complete a separate one for each student.

PLEASE CIRCLE YES OR NO

For all students:

Yes

No

I give permission for my student’s directory information to be used for school-related purposes.

Yes

No

I give permission for my student’s name, address, and telephone number to be provided upon request by law enforcement officials and authorities.

For secondary students only:

Yes

No

I give permission to release my student’s directory information to institutions of higher education.

Yes

No

I give permission to release my student’s directory information to military recruiters.

PRINT Student’s Full Legal Name Student’s Date of Birth

PRINT Parent’s/Guardian’s Full Legal Name Parent’s/Guardian’s Signature

or Eligible Student’s Full Legal Name or Eligible Student’s Signature

Date