5500-E.2

OBJECTION TO RELEASE OF DIRECTORY INFORMATION
DESIGNATIONS

The school district has designated certain categories of student information as "directory information." Directory information includes a student's name, address, telephone number (except if unlisted) and dates of attendance.

If you object to the release of any or all of the directory information listed above, you must do so in writing within 10 business days of receiving this notice. For your convenience, you may note your objections to the release of directory information on this form and return it to the Building Principal.

Please do not release directory information without my prior consent.

(Parent/Guardian or Eligible Student Signature) (Date)

Adoption date: January 27, 2000

Adoption date

January 27, 2000

11 Boice Road
P. O. Box 2033
Hyde Park, NY 12538
(845) 229-4000
For Emergency Information (845) 229-4001
District Fax: 229-4056
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