“FERPA” Parental and/or Eligible Student Consent Disclosure Form

Pursuant to the Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g and Ohio Revised Code §3319.321, parental consent or consent from the student if he/she is age 18 or older (“eligible student”) is required before personally identifiable information contained within the student’s education records are disclosed, with limited exceptions as stated in 34 CFR 99.31.

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I authorize the Quaker Digital Academy and/or Quaker Prep Academy to share information contained in the above student’s records with the individuals listed below. I understand that this authorization will remain in effect until I submit a written request to rescind it.

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Please list one individual per line that is authorized to review the student's educational records.

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