PPRA Evergreen

PPRA Notice and Consent/Opt-Out for Specific Activities

The Protection of Pupil Rights Amendment (PPRA), 20 U.S.C. § 1232h, requires Allendale Public Schools to notify you and obtain consent or allow you to opt your 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 certain physical exams and screenings.

I (Parent) Please enter your name here.

do not give permission for Please enter student's name here. For each child, a new form should be submitted.

to participate in and be excused from:

Parent Signature

Date: Please enter today's date. (MM/DD/YYYY)

School Year: Please enter the current school year (20XX-20XX).Opt-out forms will need to be resubmitted after August 1st for each school year.

School name and address:

Phone Number: Please enter your phone number.

Email Contact: Please enter your email address.

Security Check - To verify you are not a robot, please answer this question:

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