Permission to Withhold Student Directory Information Form 2023-24

Permission to Withhold Student Directory Information Form
Release of student directory information is guided by Board Policy 3250. Federal law prohibits schools from releasing student information without parent/guardian permission, except for what is termed directory information. If you do not want your student’s directory information released, please complete the form below on or before October 15 of the current school year.

Please review the information on the Permission to Withhold Student Directory Information website for additional information.
Please choose from the options below to continue.

Once you make your choice and click the "Next" button, you will view a summary of when your child's directory information will be shared and will not be shared based on your selection. You will then have to option to return to this screen or "submit" your response.
NOTE: If your child is in high school and you would like to withhold student directory information from the military or educational post-secondary institutions ONLY, please select the first option below. You can request withholding your student directory information from military and post-secondary institutions when you enter your student's information prior to submitting your form.

Request to Withhold Student Directory Information Form

Step 2 of 3

You are indicating that your child's directory information can be released to any outside organization. This is the default choice for every student unless a parent, legal guardian, or eligible student specifies otherwise.

Please click "Next" if your choice is represented in the table below.

If the table below does not represent your request, please click "Back."

Your child's directory information WILL be shared with the following:

Your child's directory information WILL NOT be shared with the following:

✅ Yearbooks
✅ Graduation Programs
✅ Athletic Programs
✅ Photo/audio/video used for district and school websites, publications, social media and/or similar purposes.
✅ PTA/PTSA
✅ Northshore Schools Foundation
✅ School Booster Clubs
✅ Parent Advisory Boards
✅ Other outside organizations when there is a legitimate educational purpose for doing so

🚫 Any outside organization when there is NO legitimate educational purpose for doing so

Request to Withhold Student Directory Information Form

Step 2 of 3

You are indicating that you would like Northshore School District to withhold your child's directory information from outside organizations except any organizations that are considered "School Support Organizations" as defined in Board Policy 4210.

Please click "Next" if your choice is represented in the table below.

If the table below does not represent your request, please click "Back."

Your child's directory information WILL be shared with the following:

Your child's directory information WILL NOT be shared with the following:

🚫 Any outside organization not considered a "School Support Organization" as defined in Board Policy 4210

Request to Withhold Student Directory Information Form

Step 2 of 3

You are indicating that you would like to request your child's directory information be withheld from all outside organizations.

Please click "Next" if your choice is represented in the table below.

If the table below does not represent your request, please click "Back."

Your child's directory information WILL be shared with the following:

Your child's directory information WILL NOT be shared with the following:

✅ Yearbooks
✅ Graduation Programs
✅ Athletic Programs
✅ Photo/audio/video used for district and school websites, publications, social media and/or similar purposes.

🚫 PTA/PTSA
🚫 Northshore Schools Foundation
🚫 School Booster Clubs
🚫 Parent Advisory Boards
🚫 Any Outside Organization

Request to Withhold Student Directory Information Form

Step 2 of 3

You are indicating that you would like to request your child's directory information be withheld from all outside organizations AND from all school/district purposes. This is the most restrictive option.

Please click "Next" if your choice is represented in the table below.

If the table below does not represent your request, please click "Back."

Your child's directory information WILL be shared with the following:

Your child's directory information WILL NOT be shared with the following:

NONE SHARED

🚫 Yearbooks
🚫 Graduation Programs
🚫 Athletic Programs
🚫 Photo/audio/video used for district and school websites, publications, social media and/or similar purposes.
🚫 PTA/PTSA
🚫 Northshore Schools Foundation
🚫 School Booster Clubs
🚫 Parent Advisory Boards
🚫 Any Outside Organization

Request to Withhold Student Directory Information Form

Step 3 of 3
Please submit your student's information:
Student's Name
Please type your student's name in the blank spaces below. You must type the name of your student as it appears in ParentVUE.

First NameMiddle NameLast Name
School
Please select your child's current school:
Student ID
Please enter your child's student ID, which can be found in ParentVUE or by contacting your child's school:
Grade
Please select your child's current grade level:
Military and Post-Secondary Educational Institutions
When students reach high school, Northshore may disclose student directory information to the military and post-secondary educational institutions. Use the checkboxes below to indicate if you would like this withheld when your student is in high school. If your child is not yet in high school, this selection can be revised in future years. (Select all that apply)
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

Permission to Withhold Student Directory Information Form

Please choose from the options below to continue.

Request to Withhold Student Directory Information Form

Request to Withhold Student Directory Information Form

Request to Withhold Student Directory Information Form

Request to Withhold Student Directory Information Form

Request to Withhold Student Directory Information Form

Please submit your student's information:

Student's Name

School

Student ID

Grade

Military and Post-Secondary Educational Institutions

Parent/Guardian Information