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503.4E2 Annual Schedule of Activities and Consent/Opt-Out Form

The Protection of Pupil Rights Amendment (PPRA) requires the District to notify you and obtain consent and/or allow you to opt your child out of participating in certain school activities. These activities include a student survey, analysis, or evaluation that concerns one or more of the following eight areas, known as “protected information surveys,” that concern one or more of the following eight areas:

(a) Political affiliations or beliefs of the student or the student’s parents;

(b) Mental or psychological problems of the student or the student’s family;

(c) Sex behaviors or attitudes;

(d) Illegal, anti-social, self-incriminating or demeaning behavior;

(e) Critical appraisals of others with whom the respondents have close family


f) Legally recognized privileged relationships, such as with lawyers, doctors,

or ministers;

(g) Religious practices, affiliations, or beliefs of the students or parents; or

(h) Income, other than as required by law to determine program eligibility.

This requirement also applies to the collection, disclosure or use of student information for marketing purposes, known as “marketing surveys,” and/or certain physical exams and screenings.

The following is a schedule of activities requiring parental notice and consent or opt-out for the upcoming school year. This list is not necessarily exhaustive and, for surveys and/or activities scheduled after the school year starts, the District will provide parents, within a reasonable period of time prior to the administration of the surveys and/or activities, notification of the surveys and/or activities and the opportunity to consent and/or opt their child out, as well as an opportunity to review the surveys.

The right to consent, and notification and opt-out transfers from parents to any student over eighteen (18) years of age or any student who is an emancipated minor pursuant to Iowa laws.

Schedule of Activities

Date: Sept./Oct.

Grades: 6, 8, 11

Activity: Iowa Youth Survey

Summary: Students in the 6th, 8th and 11th grades across the state of Iowa answer questions about their attitudes and experiences regarding alcohol and other drug use and violence, and their perceptions of their peer, family and neighborhood/community environments.


Date: May

Grades: 5

Activity: “Changing Day”

Summary: Students in 5th grade science classes are instructed in human growth and development. Both male and female students are offered some basic information about their body and how it is changing and developing.


Date: April/May

Grades: 6

Activity: Human Reproduction Summary: S

Summary: Students in 6th grade science class are instructed about the human reproduction system. Males and females are offered information regarding how their reproductive system works.


Date: Quarterly (Sept., Dec., March, May)

Grades: 8

Activity: Human Growth and Development Summary: Students in 8th grade are offered human growth and development instruction in their exploratory class.


Review of Survey and/or Instructional Material

If you wish to review any survey instrument or instructional material used in connection with any protected information or marketing survey, please submit the following request to the Superintendent at Spirit Lake Community School District. The Superintendent and/or designee will notify you of the time and place where you may review these materials. You have the right to review a survey and/or instructional material before the survey and/or material is administered to student.

I, ____________________________, request to review a survey and/or instruction material in connection with any protected information or marketing survey.

Title of Survey and/or Instructional Material: ___________________________________

Brief Description: ________________________________________________________

Date the Survey and/or Instructional Material will be Submitted to Students: __________

Parent’s Contact Information: ____________________________________________________________________________ Address City State Zip

____________________________________________________________________________ Phone Number (Cell/Home) E-mail Address


Parent’s Signature: _______________________________


Approved: 5/13/13                       Reviewed:   6/10/19                                Revised: