Parental Consent Form

Give permission for Allentown High School to share information about students who reside in Millstone Township with their home school district.

Dear Parents/Guardians,

To assist both the Millstone Township School District and Allentown High School in evaluating the effectiveness of educational programs, please consider providing consent for sharing your students’ educational records as noted below. Sharing your students’ educational record will greatly help administrators in both school districts evaluate the effectiveness of educational programming and provide vital information to ensure accountability of services offered to students in our send/receive relationship with Allentown High School. Consent will be effective for the entirety of the student’s enrollment at Allentown High School. However, consent may be withdrawn at any time via written request to the Office of the Superintendent of Schools, Upper Freehold Regional School District, 27 High Street, Allentown, NJ 08501. If you should have any additional questions, please contact Millstone Superintendent, Dr. Chris Huss, at chuss@millstone.k12.nj.us, or Upper Freehold Regional School District Superintendent, Dr. Richard Fitzpatrick, at fitzpad@ufrsd.net.

Permissions Given

FOR MILLSTONE MIDDLE SCHOOL PARENTS: By checking the boxes below, I give permission for the related middle school data/information to be shared with the administrators/counselors/child study team members in the Upper Freehold Regional School District.

Educational: Report Cards, Attendance, Standardized Testing (Including: PARCC and state science assessment-TBD) and Course Placements

Child Study Team: IEPs and all evaluations that were utilized in making the determination for the IEPs. (If a student has an IEP.)

FOR ALLENTOWN HIGH SCHOOL PARENTS: By checking the boxes below, I give permission to Allentown High School, after my student is enrolled, to provide school records and information to the Millstone Township School District accordingly.

Educational: Report Cards, Attendance, Standardized Testing (Including: PARCC, SAT, PSAT, Accuplacer, ACT, PLAN, EXPLORE, AP, ASVAB, state science assessment-TBD) Course Placements, Post High School Plans

Child Study Team: IEPs and all evaluations that were utilized in making the determination for the IEPs

FOR PARENTS WHO DO NOT WISH TO GIVE PERMISSION: By checking the box below I do not give consent for any of my child’s school data/ information to be shared.

I do not consent to the sharing of my child’s school records between the districts.

Authorization

Student's Realtime ID Number

Parent / Guardian Sign Here

First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.