Higher Education Outreach Data Notice

Higher Education Outreach Data Parental Consent Form

Higher Education Outreach Data
If your student is in grades 9–12, you may give consent to have outreach data shared with the State Board of Regents to be used strictly for the purpose of:

• providing information and resources to students in grades 9 through 12 about higher education and
• helping students in grades 9–12 enter the higher education system and remain until graduation

If you do not consent, no information will be shared with the State Board of Regents. If you do consent, only the following information will be shared:

• student name
• parent name
• student grade level
• school name and district/charter name
• primary phone number
• student email address
• student physical address

At your request, the school will provide you with a copy of the records disclosed.

_______________________________________________________________________________________________________________

By signing and dating below and returning this document, I give my consent to having outreach data shared with the State Board of Regents.

Student’s Name: ___________________________________________

Parent’s Name: ____________________________________________

Parent’s Signature: _________________________________________

Date: ____________________________________________________