Request For Non Disclosure Of High School Student Personal Information To Military Recruiters - (Section 9528 Request)
I, ________________________________, hearby exercise my federal
right, granted to me by the Congress of the United States under
Section 9528 of the Elementary and Secondary Education Act of 1965, as amended by the No Child Left Behind Act of 2001, (and any other state, federal, or local law or any school policy), and hearby request that the name, address, and telephone listing of _________________ _________________________________ (name of student), a current
student at _________________________________ (name of school), not be released to military recruiters without prior parental consent. I do, however, consent, to the disclosure of such information to institutions of higher education other than military schools.
Signed by: ___ Student ___ Parent (Check One)
__________________________________________ Signature/Date
__________________________________________ Print Name
__________________________________________ Address
__________________________________________ City/State/Zip Code
Note to students/parents: This certificate can be signed by either student or a parent. A student does not need parental consent to submit this certificate. Any secondary school student, regardless of age, can sign this certificate and is authorized by law to submit this request. Parents can also sign this certificate for any secondary student. When completed, submit this form to the school's administrative office.
Note to school administrators: You are required by federal law to comply with this request. It is a serious violation of federal law to disregard this request and release the name, address, or telephone number of this student to any military recruiter without prior written parental or student consent. Reference - Section 9528(a)(2) of the Elementary and Secondary Education Act of 1965, as amended by the No Child Left Behind Act of 2001.
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Selected Washtenaw County High School Administration Office Addresses
Huron High School - 2727 Fuller Road, Ann Arbor, MI 48105
Pioneer High School - 601 West Stadium, Ann Arbor, MI 48103
Community High School - 401 N. Division, Ann Arbor, MI 48104
Ypsilanti High School - 2095 Packard, Ypsilanti, MI 48197
Dexter High School - 2200 Parker Road, Dexter, MI 48130
Willow Run High School, 235 Spencer Lane, Ypsilanti, MI 48198
Lincoln High School, 7425 Willis Road, Ypsilanti, MI 48197
