AUHSD_ Request for Religious Exemption for Instructional Material(s)

Parent/Guardian Request for Religious Exemption for Instructional Material(s) OPT-OUT REQUEST FORM

Anaheim Union High School District
(In accordance with Mahmoud V. Taylor and applicable California Education Code)
Parents/guardians may request that their student be excused or "opted-out" of specific instruction, educational activities, or instructional materials that conflict with their sincerely held religious beliefs.

In response to an opt-out request, the Anaheim Union High School District will review the request and shall grant an opt-out request that aligns with Board-adopted policies and legal requirements.

Relevant Anaheim Union High School District Board Policies:
- RECOGNITION OF RELIGIOUS BELIEFS AND CUSTOMS 71400 (6141.2)
- TEACHING ABOUT CONTROVERSIAL ISSUES 71402 (6144)
Student and Parent Information
Student ID
Enter your student ID number
Student Name
Parent/Guardian Name
Parent/Guardian Phone

Area CodePhone Number
Parent/Guardian Email
example@example.com
School
Grade
Principal Name
Principal Email
username@auhsd.us
AP1 Name
AP2 Name
AP3 Name
AP4 Name
AP1 Email
example@example.com
AP2 Email
example@example.com
AP3 Email
example@example.com
AP4 Email
example@example.com
Senior Adm Name
Senior Adm Email
example@example.com
Director, Learning and Development Name
Director, Learning and Development Email
username@auhsd.us
Lesson, Book, or Educational Activity that May Conflict with Sincerely Held Religious Belief(s)
Teacher:
Teacher Email:
username@auhsd.us
Subject Area/Class
Title of Lesson/Book/Activity
Planned Dates(s) of Instruction: Provide Dates, or From: Date To: Date
Basis for Request
1. Please describe the specific religious belief(s), custom(s) and/or practice(s) with which the specific instructional content (described above) substantially interferes with:
2. Please describe how the specific instructional content substantially interferes with the specific religious belief(s), custom(s) and/or practice(s):
Parent/Guardian Input on Alternative Instruction (Optional)
Please suggest an alternative title, resource, or activity that you believe would be acceptable for your student and may meet the same lesson objectives:
Parent/Guardian Signature:

By submitting this form, I affirm that this request is based on sincerely held religious beliefs. I understand the District will conduct a fact-intensive inquiry in response to this request and may contact me for additional clarification. I understand that if the opt-out request is granted, the District will make reasonable efforts to accommodate this request consistent with District policy and legal requirements. I understand that my student may be provided with an alternative assignment that meets the instructional goals.
Parent/Guardian Signature:

Clear
Date

MonthDayYear
Date
Submission Information

Students will not be penalized academically or otherwise for being opted out. Students will be given an alternative educational activity during the opt out period if applicable.

This form must be returned in person to the principal of the school in order for it to be considered and any action taken.
- Date Received
  
  MonthDayYear
  Date
- Reviewed by
- ApprovedDenied
- Notes
Should be Empty:

Parent/Guardian Request for Religious Exemption for Instructional Material(s) OPT-OUT REQUEST FORM