Early Childhood Enrollment Application - Kootasca Community Page 2
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4Tennessen Warning
Your Privacy Rights
This sheet tells you about your rights under the Minnesota Government Data Practices Act (“the Act”). This Act protects your privacy, but also
lets us give information about you to others if a law requires it AND we tell you before we do it. The information below tells why and when we
will ask for and give information about you. Under the Act, information about individuals is divided into four categories.
What kind of information do we collect?
Public Information: Information about you that is available to anyone.
Private Data: Information about you that can be shared only if you give us your permission or if a law allows or requires us to share the
information.
Confidential Information: Information about you that cannot be shared about you.
Summary Information: Information about you that does NOT identify you personally, which may be shared with others, generally for
reporting purposes.
Generally, we only ask for two types of information from you, public and private information. We use summary information for reports but it
does not identify you or anyone else by name or other identifying information.
Why do we ask you for this information?
We ask this information so we can:
Enroll your child in an Early Childhood Education Program.
Tell you apart from other persons with the same or similar name.
Decide if you can receive services from us, and what or how much you can receive.
Help you obtain financial or social services from other agencies or companies.
Make reports, do research, audits and evaluate our programs.
Collect money from the government for help we give you.
Do you have to answer the questions we ask?
What will happen if you do not answer the questions we ask?
Generally, you do not have to give us information. However, if you do not provide us the information, we may not be able to determine whether
we can help you, or get help for you from other agencies.
Who else may see this information?
A third-party entity will evaluate the effectiveness of the ECE Scholarships program for the Minnesota Department of Education. That entity is
bound by Minnesota’s data practices and privacy laws and may not share your data with any other private entities but will share its evaluation
with the Minnesota Department of Education. We may also give the data you’ve provided to the Legislative Auditor, the Minnesota Department
of Human Services and any law enforcement agency or other agency with the legal authority to access the information, and anyone authorized by
a court order.
How else may this information be used?
We can use or release this information only as stated in this notice unless you give us your written permission to release the information for
another purpose or to release it to another individual or entity. The information may also be used for another purpose should the United States
Congress or the Minnesota Legislature pass a law allowing or requiring us to release the information or to use it for another purpose.
You have the right to copies of information we have about you.
You may ask if we have any information about you.
If we have information about you, you may ask for copies.
You may give other people permission to see and have copies of private data about you.
If you do not understand the information, you may ask to have it explained to you.
You may ask for and receive a copy of the agency’s Data practices policy.
How long will my data be kept?
Your data will be maintained for up to nine years.
How do you appeal if you think information is not accurate or complete?
st
Call the
Invest Early Project
218-327-5850. Your objection may also be in writing and sent to
820 NW 1
Avenue, Grand Rapids MN 55744.
If
th
applying strictly for
Head Start
call the
KOOTASCA office at 218-999-0814
Your objection may also be in writing and sent to
201 NW 4
Street;
Suite 130, Grand Rapids, MN
55744. You must tell us why the information is not accurate or complete. You may send your own explanation of
the facts you disagree with. Your explanation will be attached any time that information is shared with another agency. For more information on
how to do this, please call the Invest Early Project office.
If you have any questions about the information on this form, please call the Early Childhood Education Program listed above.
Last Name
First Name
Middle Name
Student Applicant
Student Applicant
Student
Date
Parent / Guardian Signature
Early Childhood Application Form 2016-2017
Revised 10/30/2015
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