[date]

[school organization or official]_

__[address]_________________

Re:  [Student Name] Mental Health Survey, Analysis or Evaluation

Dear _________________:

This is to notify you that pursuant to the The 1998 Protection of Pupil Rights Amendment (PPRA),  as amended by the 2003 No Child Left Behind Act, which is codified at 42 USC §1232h(b)(2), that under no circumstances is the school district, any school within the school district or through any other means is [Student Name] to submit to any survey, analysis, or evaluation for mental or psychological problems.  As set forth below, 42 USC §1232h(b)(2) specifically prohibits any such survey, analysis, or evaluation without my/our permission:

No student shall be required, as part of any applicable program, to submit to a survey, analysis, or evaluation that reveals information concerning - . . .

(2) mental or psychological problems of the student or the student's family;

YOU ARE HEREBY NOTIFIED that under no circumstances may any survey, analysis, or evaluation concerning mental or psychological problems of [Student Name] be conducted

Compliance with this federal law is mandatory and is expected.  I/we appreciate your cooperation and compliance with this lawful directive.

Sincerely,

[Parent]