The Protection of Pupil Rights Amendment (PPRA) requires the Columbus Community School District to notify you and obtain consent and/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, known as “protected information surveys”:
(a) Political affiliations or beliefs of the student or the student’s parents;
(b) Mental or psychological problems of the student or the student’s family;
(c) Sex behaviors or attitudes;
(d) Illegal, anti-social, self-incriminating or demeaning behavior;
(e) Critical appraisals of others with whom the respondents have close family relationships;
(f) Legally recognized privileged relationships, such as with lawyers, doctors or ministers;
(g) Religious practices, affiliations or beliefs of the students or parents; or
(h) 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, known as “marketing surveys,” and/or certain physical exams and screenings.
The following is a schedule of activities requiring parental notice and consent or opt-out for the upcoming school year. This list is not necessarily exhaustive and, for surveys and/or activities scheduled after the school year starts, the Columbus Community School District will provide parents, within a reasonable period of time prior to the administration of the surveys and/or activities, notification of the surveys and/or activities and the opportunity to consent and/or opt their child out, as well as an opportunity to review the surveys.
The right to consent and notification and opt-out transfers from parents to any student over eighteen (18) years of age or any student who is an emancipated minor pursuant to Iowa laws.
Schedule of Activities
[Activity 1 (Requiring Consent)]
Date: [COMPLETE]
Grades:
Activity:
Summary:
Consent: A parent must sign and return to the superintendent at ____________________, the form below no later than [DATE] so that your child may participate in this activity.
I, ____________________________, give my consent for ________________________ to take participate in the above referenced activity.
Parent’s Signature: _______________________Date: ________
[Activity 2 (Permitting Opt-Out)]
Date: [COMPLETE]
Grades:
Activity:
Summary:
Opt-Out: A parent wishing to opt his/her child out of this activity must contact the superintendent at __________________________, telephone number: ______________, no later than [DATE] and indicate that you do not wish for your child to participate in this activity.
Review of Survey and/or Instructional Material
If you wish to review any survey instrument or instructional material used in connection with any protected information or marketing survey, please submit the following request to the superintendent at __________________________. The superintendent and/or designee 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 material before the survey and/or material is administered to student.
I, ____________________________, request to review a survey and/or instruction material in connection with any protected information or marketing survey.
Title of Survey and/or Instructional Material: ___________________________________
Brief Description: ________________________________________________________
Date the Survey and/or Instructional Material will be Submitted to Students: __________
Parent’s Contact Information: _____________________________________________________________
Address City State Zip
_____________________________________________________________
Phone Number (Cell/Home) E-mail Address
Parent’s Signature: __________________________ Date: ________