Consent to Release of Education Records Under the Family Educational Rights and Privacy Act (FERPA) Consent to Release of Education Records Under the Family Educational Rights and Privacy Act (FERPA) As part of Youth Connect, your child has been identified as a student who may be able to benefit from the partnership between the New Haven Public Schools and various New Haven community agencies to help improve school attendance and performance, community engagement, and college and career readiness upon graduation from high school. To better get to know you and your child and identify the resources that may be appropriate to help, we need parental consent to review your child’s educational records in a confidential meeting setting, to be attended by the members of Youth Connect. The membership of Youth Connect (formerly known as Youth Stat) will include, but is not limited to, appropriate staff from the New Haven Public Schools, the City of New Haven Youth and Recreation Department, and the following representative agencies: New Haven Housing Authority, Clifford Beers Clinic, Yale Child Study Center, Hill Health Center, Post Traumatic Stress Center, Connecticut Department of Children and Families, Connecticut Violence Intervention Program, Juvenile Review Board, Connecticut Court Supported Services Division, including Juvenile Probation, Youth Continuum, and other prevention and community agencies. Each of these agencies has been asked to designate appropriate staff to serve on the Committee to review individual student cases and refer students to appropriate community resources on a case-by case basis. Additional agencies may be added to the Committee over the course of your child’s involvement in the initiative. Information from your child’s school records will stay with Youth Connect and will not be used by the individual agencies that make up the membership of the Committee for any purpose unless you give your specific consent for release of your child’s records to a specific community agency. Each participating partner will sign an agreement with New Haven Public Schools requiring it to maintain the confidentiality of your child’s information in accordance with these requirements. You will be provided with regular updates on the work of the Committee in regard to your child. Parent involvement is instrumental, and we encourage collaboration between Youth Connect and families. Once the records are no longer needed by the Youth Connect, they will be returned to the New Haven Public Schools, and any duplicates made shall be destroyed. If community resources are identified as being appropriate to assist you and your child, you will be asked to provide separate consent for the release of records and information needed to make that referral to the outside agency. Student's School * Select Your SchoolAdult EducationAugusta Lewis TroupBarack H. Obama Magnet University SchoolBarnard Enviromental MagnetBenjamin Jepson MagnetBetsy Ross Arts MagnetBishop Woods Architecture & DesignBrennan Rogers School of Communication and MediaCelentanoClemente Leadership AcademyClinton Avenue SchoolColumbus Family SchoolConte West Hills SchoolCooperative Arts And HumanitiesDavis Academy for Arts and Design InnovationDr. Reginald Mayo Early Learning CenterEast Rock SchoolEdgewood SchoolElm City MontessoriEngineering & Science University Magnet SchoolFair Haven SchoolHigh School In The CommunityHill Central Music AcademyHill Regional Career MagnetJames Hillhouse High SchoolJohn C Daniels School of International CommunicationJohn S Martinez Sea & Sky STEM Magnet SchoolKing Robinson Interdistrict Magnet SchoolLincoln-Bassett SchoolLW Beecher School of Arts and SciencesMauro Sheridan Science, Technology & Communications SchoolMetropolitan Business AcademyNathan Hale SchoolNew Haven Academy MagnetQuinnipiac SchoolRiverside AcademyRoss Woodward ClassicalSound SchoolTruman SchoolWest Rock Authors Academy MagnetWexler-Grant SchoolWilbur Cross High SchoolWorthington Hooker School Student CONSENT/AGREEMENT I consent and provide permission to New Haven Public Schools (“NHPS”) to share personally identifiable information from my child’s education records, including but not limited to academic, attendance and disciplinary history; cumulative records; test scores; coursework and grades; student success plans; health records; special education or Section 504 records; and confidential files including records or information from any school counselor or social worker, with the Committee. I further authorize NHPS to discuss personally identifiable information from my child’s education record with the Committee. In addition, I authorize Committee members to share and discuss the personally identifiable information they have concerning my child’s education record within the Committee and amongst its members. These authorizations shall remain valid for one (1) calendar year unless specifically revoked by me. I understand that providing consent to the sharing of this information is completely voluntary and that my child is not required to participate in the New Haven School Change initiative Committee as a condition of attending the New Haven Public Schools. Student’s Name * ID * DOB * 18 years or older? * Please SelectYesNo Parent / Guardian or Student Signature Name * Email * Signature * signature keyboard Clear Date * Parent / Guardian Signature Print Parent/Guardian Name * Email * Signature * signature keyboard Clear Date * If you are human, leave this field blank. 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