ADE Director's Communication Memo Form

Memo Number : COM-10-054

Date Created : 09/29/2009


Co-op Directors
Secondary Principals
Elementary Principals
other: School Nurses

Type of Memo: Informational
Response Required: No
Section:   Special Assistant - Dee Cox
FERPA Consent for School Flu Immunization Clinics

Regulatory Authority:

Contact Person:
Paula Smith

Phone Number:


As a follow up to COM-09-154, the Arkansas Department of Health (ADH) is working with school districts in providing free seasonal influenza vaccine and H1N1 influenza vaccine to any child whose parent completes the required consent forms for vaccine administration. For the school districts with scheduled clinics, the district will receive seasonal flu vaccine. If the H1N1 vaccine has arrived in the state before a districtís vaccine clinic, the school clinic will be able to provide H1N1 immunizations as well. In order to provide the vaccines, school districts will be provided three (3) documents from the ADH via the local health unit (LHU). The documents include: (1) Dear Parent letter with Arkansas Fights the Flu logo; (2) Vaccine Information sheet (VIS); and (3) ADH consent form. The only document to be photocopied by school districts will be the Family Education Rights to Privacy Act (FERPA) consent attached to this memo. Districts will need to download the FERPA consent, insert the districtís letterhead and produce copies for all students. This FERPA consent will be distributed with the ADH documents.

The Dear Parent letter outlines all actions parents should take so the student will be able to receive the vaccine(s). It is imperative that parents return the signed ADH consent form AND the signed FERPA consent form in order for the student to receive one or both vaccines. If the parent returns the FERPA and ADH consents, the school will sort the ADH consents separating the studentsí consents that also have signed FERPA consents from those that do not have a signed FERPA consent.

For questions regarding vaccine information, call the local health unit. Contact information for all Health Units can be found at


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