Military Opt-out Form - Monona Grove Schools

Parental Objection to Release of High School Student
Information to Military Recruiters
A recently enacted federal law mandates the release of the name, address and telephone
number of your child to military recruiters and institutions of higher learning.
The law provides, in relevant part, that the school district “(1)…shall provide, on a
request by a military recruiter or an institution of higher education access to secondary
school students’ names, addresses and telephone listings, (2) Consent – A secondary
school student or the parent of the student may request that the student’s name, address
and telephone listing described in paragraph 1 not be released without written parental
consent…”
According to the new law, you may request that your child’s name, address and telephone
listing not be released without your consent.
If you do not want your child’s name, address and telephone listing provide to military
recruiters, please fill out this form.
If you do not completely fill out the form and sign it, your child’s name, address and
telephone listing will be made available to military recruiters.
Mail or delivery this form to:
Monona Grove High School
Student Services Admin Asst
4400 Monona Dr
Monona WI 53716
I hereby request that the name, address and telephone number of my child
_____________________________ ____________ _________________
Print name of child Student ID Date of Birth
not be released to military recruiters.
_____________________________ _________________________ __________
Signature of Parent/guardian Print Name of Parent/Guardian Date

5-25-10