Student Contact Information Form - Baltimore City Public Schools Page 2
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2Opt-out of Release of Directory Information
Baltimore City Public Schools (City Schools) may disclose appropriately designated “directory information” without written consent,
unless you opt out of some, or all, of its release. The Family Educational Rights and Privacy Act (FERPA), a Federal law, defines
directory information as information that is generally not considered harmful or an invasion of privacy if released. Those categories
of information include student name, address, telephone number, photographic image, participation in activities and sports, height
and weight (if on an athletic team), years in attendance at City Schools, grade level, major field of study, degrees, honors and awards
received, and most recent educational institution attended prior to City Schools.
Two federal laws require City Schools to provide military recruiters, upon request, with student names, addresses and telephone
listings unless parents/guardians have advised City Schools that they do not want their student’s information disclosed without their
prior written consent.
If you give your consent to the release of your student’s directory information as described above you DO NOT need to complete
or return this form. If you do not want City Schools to disclose directory information from your child’s education records without
your prior written consent, you must notify City Schools by completing and signing this opt out of release of directory information
form and returning it to the named student’s school by September 30, 2015. If you do not give your consent to allow City School’s to
release your student’s directory information then please check all that apply:
In City Schools materials (e.g., playbills, team rosters, school websites, social media, etc.)
To United States military recruiters
To institutions of higher learning
To any organization of parents, teachers, students or former students; businesses; agencies; governmental or political
offices; or any combination of these groups
To the media
To anyone
Home Language Survey
In accordance with federal and state requirements, City Schools conducts the Home Language Survey of all students to assist in
identifying language minority students. The Home Language Survey provides a broad indicator of which students may require further
assessment to determine eligibility for English for Speakers of Other Languages (ESOL) services.
Student’s country of birth: __________________________________________________________________________________
What was the language your child first learned to speak?
ने प ाली (Nepali)
Español (Spanish)
English
ትግርኛ (Tigrinya)
( ةيبرعلاArabic)
kiSwahili (Swahili)
( ودراUrdu)
Français (French)
粤语 / 粵語 (Chinese, Cantonese)
普通话 / 國語 (Chinese, Mandarin)
Tagalog (Tagalog)
Other:
Wollof (Wolof)
Tiếng Việt (Vietnamese)
አማርኛ (Amharic)
______________
What language do you use most often at home? _________________________________________________________________
_____________________________________________________
___________________________________
Parent, guardian, or eligible student signature
Date
Please print and fully complete BOTH SIDES of this form.
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