Student and Family Privacy Rights – Consent Form
The Protection of Pupil Rights Amendment (PPRA), requires RISE Charter School to notify you and obtain consent or allow you to opt your child out of participating in certain school activities. These activities include student surveys, analyses, or evaluations that concern one or more of the following eight areas (“protected information surveys”):
- Political affiliations or beliefs of the student or student’s parent;
- Mental or psychological problems of the student or student’s family;
- Sex behavior or attitudes;
- Illegal, anti-social, self-incriminating, or demeaning behavior;
- Critical appraisals of others with whom respondents have close family relationships;
- Legally recognized privileged relationships, such as with lawyers, doctors, or ministers;
- Religious practices, affiliations, or beliefs of the student or parents; or
- 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 (except those permitted under State law without parental notification). The following is a schedule of activities requiring parental notice and consent or opt-out for the upcoming school year. This list is not exhaustive and, for surveys and activities scheduled after the school year starts, RISE Charter School will provide parents, within a reasonable period of time prior to the administration of the surveys and activities, notification of the surveys and activities and provide them with an opportunity to opt their child out, as well as an opportunity to review the surveys. (Please note that this notice and consent/opt-out transfers from parents to any student who is 18 years old or an emancipated minor under State law.)
If you wish to review any survey instrument or instructional material used in connection with any protected information or marketing survey, please submit a request to the Executive Director. The Executive Director will notify you of the time and place where you may review these materials. You have the right to review a survey and/or instructional materials before the survey is administered to a student.
I ______________ (parent/guardian’s name) give my consent for _____________ (child’s name) to take __________________ (survey name) on or about ___________ (date).
Parent’s signature: _________________________
Please return this form no later than ___________ (date) to the following school address:
RISE Charter School Front Office
203 Center Street West
Kimberly, ID 83341