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Collective for Youth - NorthStar 2020-2021

Consent to Release Student Records Omaha Public Schools

The Omaha Public Schools (OPS) seeks to support students and families and to remove barriers to success in school. OPS works with Omaha area community organizations to provide district identified needs and student and family support programs. Organizations working with OPS are required to monitor and report student progress toward program goals.

Program staff views student information stored by the United Way of the Midlands and by OPS. End of year data is provided and the program uses the information to monitor and evaluate their services. OPS must approve any research to study the impact of participation in this community program using the student information.

The consent of a parent or a legal guardian of the student is required for OPS to release the requested student information from your child’s education records. Eligible students age 18 or older may consent to the release of their own student records.

By signing this form, I give consent to the Omaha Public Schools to release all of the student information in the categories/examples listed below. I give consent to the Omaha Public Schools to release any additional student information approved by OPS in the future to the program and the United Way of the Midlands. (Signature and date required below).

Student Demographic Information

District, State ID Numbers
Student Name, Date of Birth, Addresses Gender, Race, Ethnicity Home/Correspondence Language, ELL, LEP Enrollment, School, Grade

Parent / Guardian Demographic Information

Name, Relationship to Student, Address, Telephone Numbers

Emergency Contact Information

Name, Relationship to Student, Telephone Numbers
This Consent to Release Student Records expires upon any of the following events, whichever comes first:

Attendance

Absences, Dates, Reasons

Schedule / Grades / GPA

Class Schedule, Grades, GPAs Transcripts/Credits

District, State, and National Test Scores

Not to include scores for internal OPS use only

School and Program Staff Communication

 

  1.  When my child no longer participates in the program, or (agency to inform OPS-SIS)
  2. When my child transfers from OPS, levels up from elementary to middle school, or middle to high school
  3. When OPS releases end of year data after one of the preceding events, or
  4. When a parent/guardian requests OPS Student Information Services to revoke the consent.

By typing your full legal name in the E-Sign box you are electronically signing this document.


    
     
   
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