WASHOE COUNTY SCHOOL DISTRICT INFINITE CAMPUS …
WASHOE COUNTY SCHOOL DISTRICT INFINITE CAMPUS PARENT PORTAL FERPA CONSENT FORM
I consent to the disclosure of the following educational records of my child through access of Infinite Campus Parent Portal (ICPP). I understand that the following educational records will be available to be viewed through ICPP. I am giving permission (consent) for access to my child's information. This information will be provided to the person(s) named below.
Student Information:
(Please print)
Last Name
First Name
Middle Name
Date of Birth
All of the following educational records are approved for release:
District Notices
Assignments
Transcripts
School Notices
Schedule
Assessment
Reports
Teacher Messages
Attendance
Calendar
Family (Such as telephone, e-mail, and relationships)
Health (Immunization) To Do List Behavior
Name of individual parent/guardian you wish to provide access to ICPP:
Print Name Print Name Parent/Guardian (Print name)
Address Address
Parent/Guardian (Signature)
Date
Written consent of parents is usually required for the release of personally identifiable records or other information protected by the Family Education and Privacy Act to agencies or individuals. Agencies or individuals may not share information with any other party without the written consent of the parents unless entitled to do so under FERPA 99.33.
You may revoke this authorization at any time. Unless revoked earlier, this consent will remain in effect until June 30 of the current school year. Note: The party receiving the educational records is hereby notified of the following:
(1) The educational records are to be used only for the described purpose; (2) The educational records may not be re-disclosed without written consent of the parent,
guardian, or eligible student.
Washoe County School District Office Use Only:
Records/Information provided on
to
Date
Name of Individual/Department
Signature of Designated Staff Person Fulfilling Request
Date
. 06/2011
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