Protection of Pupil Right Amendment (PPRA) Notice and Survey Opt-Out

The Protection of Pupil Rights Amendment (PPRA), 20 U.S.C. § 1232h, requires the School District to notify you and obtain consent 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 (“protected information surveys”):

  1. Political affiliations or beliefs of the student or student’s parent;
  2. Mental or psychological problems of the student or student’s family;
  3. Sex behavior or attitudes;
  4. Illegal, anti-social, self-incriminating, or demeaning behavior;
  5. Critical appraisals of others with whom respondents have close family relationships;
  6. Legally recognized privileged relationships, such as with lawyers, doctors, or ministers;
  7. Religious practices, affiliations, or beliefs of the student or parents; or
  8. Income, other than as required by law to determine program eligibility.

This requirement also applies to certain physical exams and screenings.

Following is a schedule of activities requiring parental notice and consent or opt-out for the upcoming school year. This list is not exhaustive and, for surveys and activities scheduled after the school year starts, the School District will provide parents with prior notification of the surveys and activities and the opportunity to opt their child out, as well as an opportunity to review the surveys. (Please note that the rights described in this notice transfer from parents to any student who is 18 years old or an emancipated minor under Iowa law.)

Activity: Social and Emotional Health Screening

Dates: Twice during the 2019-20 school year: once the first semester (between September 30, 2019 – November 22, 2019) and once the second semester (between March 2, 2020 – May 1, 2020).

Grades: 4, 6, 9, 11

Summary: This is a survey that asks students questions about their social and emotional health, family and school safety.   

My signature below states: I do not want my child/children listed below to participate in the Social/Emotional Health Screener. I understand that a neutral activity will be provided for them during the survey time and that there is no penalty for not participating. I understand that this refusal of consent needs to be received by the school system no later than September 15, 2019. 

Names of child/children who will not participate in the Social/Emotional Health Screening:

Opt-out Process: Parents/guardians can opt a student out of all Social and Emotional Health Screenings by completing the online form for Protection of Pupil Right Amendment (PPRA) Notice and Survey Opt-Out by September 15, 2019.

Parent Signature *

Right to Review Survey Materials:

If you wish to review any survey instrument or instructional material used in connection with any protected information or survey, please submit a request to your school administrator.  You will be notified of the time and place where you may review these materials. You have the right to review a survey and/or instructional materials before the survey is administered to a student.


The Sioux City Community School District offers career and technical programs in the following areas: Business & Marketing, Family & Consumer Science, Health Science, and Industrial Arts, Technology, & PLTW.

The Sioux City Community School District is an equal opportunity/affirmative action employer. It is an unfair or discriminatory practice for any educational institution to discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, genetic information (for employment), national origin, religion, age (for employment), disability, socioeconomic status (for programs), marital status (for programs), or veteran status (for employment) in its educational programs and its employment practices.

Inquiries or grievances, including Section 504 grievances and grievances under Title II of the Americans with Disabilities Act, may be directed to Jen Gomez, Director of Student Services & Equity Education at 627 4th Street, Sioux City, IA 51101, (712) 279-6075, Please see District Board policies 103 and 504.4 for additional information on available grievance procedures.