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5145.15FORM#1 NOTIFICATIONTOPARENTS ReleaseofCertainInformation UndertheNoChildLeftBehindAct 20 Apparent/Guardian: PursuanttothefederalNoChildLeftBehindAct, P.L.107110(Title, Sec.9528), theStaffordSchoolDistrict
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Fill out the form by providing all the required information.
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Make sure to include the names of the parents or guardians exercising the option to withhold their consent.
05
Indicate the specific information that should be withheld from release.
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Who needs parentsguardianswishingtoexerciseformiroptiontowithholdformirconsenttoformreleaseofformaboveinformation?

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Parents or guardians who wish to exercise their option to withhold consent to the release of the above-mentioned information.
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Parents/guardians wishing to exercise form IR option to withhold form IR consent to form release of form above information are choosing not to allow the release of the mentioned information.
Parents or guardians of the individual for whom the information relates are required to file this form.
The form should be filled out completely and accurately, following the instructions provided.
The purpose is to protect the privacy of the individual by not allowing the release of the specific information mentioned on the form.
The specific information that the parents/guardians do not want to be released should be reported on this form.
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