STUDENT OPT OUT FORM

regarding the

RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER

School ______________________

Date ________________

Student Name_______________________

Date of Birth _________

As a student you have the right to request that your private information is not released to military recruiters and others. Complete this Opt-Out form and give it to your Principal or School Administrator by October 22, 2004.



__ I request that this student’s name, address, and telephone number not be released to Armed Forces and Military Recruiters, or Military Schools.

__ I request that this student’s name, address, and telephone number not be released to colleges, universities, or companies seeking employees.

Signature of student _______________________________________

Signature of parent or guardian ______________________________



Federal public law 107-110, section 9528 of the ESEA, "No Child Left Behind Act" requires school districts to release student names, addresses, and phone numbers to military recruiters upon their request. Students are then called at home by recruiters and pressured to join the military. The law also requires the school district to notify you of your right to Opt-Out from this by requesting that the district not release your information to military recruiters. The completion and return of this form serves as your request to withhold your private information. Turn in the completed form by October 22, 2004.

Form provided by Coalition Against Militarism in Our Schools

http://www.militaryfreeschools.org

Contact info@militaryfreeschools.org or 626-799-9118 if you have questions.