Ppra Notice And Consent/opt-Out Form printable pdf download

PPRA Notice and Consent/Opt-Out

The Protection of Pupil Rights Amendment (PPRA), 20 U.S.C. § 1232h, requires [School District] to notify

and obtain consent or allow parents/guardians to opt child out of participating in certain school

activities. These activities include a student survey, analysis, or evaluation that concerns one or more of

the following eight areas (“protected information surveys”): 1. Political affiliations or beliefs of the

student or student’s parent; 2. Mental or psychological problems of the student or student’s family; 3.

Sex behavior or attitudes; 4. Illegal, anti-social, self-incriminating, or demeaning behavior; 5. Critical

appraisals of others with whom respondents have close family relationships; 6. Legally recognized

privileged relationships, such as with lawyers, doctors, or ministers; 7. Religious practices, affiliations, or

beliefs of the student or parents; or 8. Income, other than as required by law to determine program

eligibility. This requirement also applies to the collection, disclosure or use of student information for

marketing purposes (“marketing surveys”) and physical exams and screenings.

I __________________________________________do not give my consent

(parent/guardian’s name)

for_______________________________,

(child’s name)

to participate in any student survey, analysis, class, evaluation or other activity pertaining to any of the

above-listed eight categories, and I direct that said child be excused from any such activities including

any of the following testing/assessment:

ACT Explore, ACT Plan, ACT Quality Core End-of-Course Assessments, ACT WorkKeys, ACT Plus Writing

Assessment, ACT Aspire, Alabama Science Assessment, National Assessment of Educational Progress

(NAEP)

( __) Student should also be opted-out of preliminary pre-testing associated with the assessments.

My child should not be considered truant, have an unexcused absence, be punished, be criticized or

ostracized in any way for opting out. Thank you for your cooperation.

____________________________________________________

Parent’s signature

Please make a copy for parent and place initial of school personnel receiving form here: __________.

Date: __________________________

School Year: ____________________

School Name and Address:__________________________________

Ppra Notice And Consent/opt-Out Form