Code No.: 506.2E3
AUTHORIZATION FOR RELEASING STUDENT DIRECTORY INFORMATION
The Anamosa Community School District has adopted a policy designed to assure parents and students the full
implementation, protection and enjoyment of their rights under the Family Educational Rights and Privacy Act of 1974
(FERPA). A copy of the school district’s policy is available for review in the District Office at 200 S. Garnavillo St.,
Anamosa, IA 52205.
This law requires the school district to designate as “directory information” any personally identifiable information
taken from a student’s educational records prior to making such information available to the public.
The school district has designated the following information as directory information:
Participation in officially recognized activities and sports
Weight and height of member of athletic teams
Dates of attendance
Degrees and awards received
The most recent previous educational agency or institution attended by the student
Photograph and other likeness
Other similar information
You have the right to refuse the designation of any or all of the categories of personally identifiable information as
directory information with respect to your student provided that you notify the school district in writing not later than
September 15 of this school year. If you desire to make such a refusal, please complete and return the slip attached to
If you have no objection to the use of student information, you do not need to take any action.
RETURN THIS FORM
Anamosa Community School District Parent/Guardian Directions to
Withhold Student/Directory Information for Education Purposes, for 20 – 20 school year.
Student Name: Date of Birth
(Signature of Parent/Legal Guardian/Custodian of Child) (Date)
This form must be returned to your child’s school no later than September 15 of the current school year.
Additional forms are available at your child’s school.
Code No.: 506.2E3