Form Ccf-588 - Annual Release And Network Access Form - Clark County School District
Download a blank fillable Form Ccf-588 - Annual Release And Network Access Form - Clark County School District in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Ccf-588 - Annual Release And Network Access Form - Clark County School District with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Clark County School District
9998-500588
CCF-588
06/10
ANNUAL RELEASE AND NETWORK ACCESS FORM
Student Name: ______________________________________________________________ School Year:____________________________
School: ______________________________________Grade: _______Track: _______Student ID Number: _______________________
Please read the attached Instruction Sheet carefully before signing this document. The parent/guardian must complete all three
sections below: (1) Restrict Release of Directory Information; (2) Media Release; and (3) Computer Network Access.
1. RESTRICT RELEASE OF DIRECTORY INFORMATION (to be completed by parent/guardian)
FERPA allows the Clark County School District to release Directory Information (which is defined in the “Instruction Sheet”) without the
consent of the parent/guardian. However, a parent/guardian has the right to opt-out of that disclosure. I hereby request that Directory
Information for my student NOT be released to the following agencies or organizations:
If you do NOT want to restrict the release of Directory Information leave this section #1 blank.
Withhold Directory Information from Military Only
Withhold Directory Information from all outside agencies
Withhold Directory Information from all outside agencies, and also restrict Directory Information in CCSD school
publications such as the annual yearbook, playbills, honor roll or other recognition lists, graduation programs, newsletters,
and sports activity programs/sheets.
2. MEDIA RELEASE (to be completed by parent/guardian)
I
give
do not give permission for the Clark County School District to release my student’s name, photograph,
and/or audio/video/film reproduction for use in internal media publications, newspaper articles, television coverage,
newsletters (including school newsletters, other than Directory Information in school newsletters which is covered in #1
above), video presentations, and/or school district presentations. I understand that the material may be reduced to either
print or electronic format, and may be utilized in internal media sources.
I
give
do not give permission for the Clark County School District to release my student’s name, photograph,
and/or audio/video/film reproduction for use in external media publications, newspaper articles, television coverage,
websites (including CCSD.net), newsletters (including school newsletters when posted on external websites), video
presentations, and/or school district presentations. I understand that the material may be reduced to either print or electronic
format, and may be utilized in external media sources.
3. COMPUTER NETWORK ACCESS (to be completed by parent/guardian)
I
give
do not give permission for my student to access, produce, video conference, and communicate
information on the District computer network resources in accordance with the Acceptable Use Policy of the Clark County
School District. Student work, artwork, or projects will be identified by first name, grade, and school only. Students who do
not have parent/guardian permission to use the District’s computer network will be given alternative educational activities.
The signature of the parent/guardian below applies to all three sections set forth above.
____________________________________________________________________________________________________________________
Printed Name of Parent/Guardian
____________________________________________________________________________________________________________________
Signature of Parent/Guardian
Date
COMPUTER NETWORK ACCESS (to be completed by student)
I understand and will abide by the Acceptable Use Policy of the Clark County School District. I understand that violating the
Acceptable Use Policy may result in loss of network privileges and/or other District disciplinary measures.
____________________________________________________________________________________________________________________
Student Signature
Date
012/100 Distribution:
Original/White: School
2nd Copy/Yellow: Parent/Guardian/Student
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal