MAKE A FEW CHANGES AND THIS LETTER CAN BE USED IN ANY STATE

OPT-OUT OF THE WISCONSIN YOUTH RISK BEHAVIOR SURVEY
                                           QUESTIONNAIRES
Name of District Superintendent
Name of School District
Address of School District
Date of opt-out letter
Dear (Name of Superintendent):
Please opt-out (first and last name of child) from (Name of survey or surveys used by your school district).
The only personal information you are allowed to record about my child is the information I provide which is needed to help my child academically. That information is NOT to be shared with anyone other than the teachers and principals who work with my child during the (put in school year: 2014-2015) school year. That information is NOT to follow my child to the next school year. If the information provided continues to be relevant, I will offer that information to new teachers and administrators as I deem necessary.
Thank you for respecting my child’s right to privacy.
Sincerely,
Your Name
Your address
Your phone number
CC to all teachers and principals who work with your child and to the President of the school board.






(PARENTS MUST OPT-OUT EACH SCHOOL YEAR.)

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