Please print, fill out the appropriate section, sign and return this letter by mail to the address below.
Teacher's Request for Information
Lectorum Publications
205 Chubb Avenue
Lyndhurst, NJ 07071

Section 1
I am writing to revoke the consent I provided on behalf of my students and their parents when I created my class username and password, and to request that you remove from your records all personally identifiable information that you may have collected from students in connection with that class username. I understand that once I have revoked my consent, Lectorum must delete my class username and password, and that none of myself, my students or their parents will be able to use this class username to access class activities on Lectorum.com. Please notify me when my class username has been deleted.

My personal username is __________________________________________

My class username is _____________________________________________

Section 2
My name is ________________________ [your full name]. I am writing to inquire about personal information you may have collected online from one of my students in association with Lectorum Global Classport. In order for you to do a comprehensive check of your records, I understand that I need to provide you with the following information:

My student's name is ________________________ [student's first and last name].
My student's Lectorum Global Classport ID is ________________________ .

[Check boxes that are applicable:]

I would like to review any personally identifiable informtchrequestation you have collected from this student.

I would like you to remove any personally identifiable information you have on this student from your records and terminate this student's Lectorum Global Classport account.

By my signature, I affirm that I am the teacher of the student with the personal information that I have provided in this letter. I understand that from the information I have provided in this letter, you have no way of knowing whether this student is participating in other activities using another name and/or Global Classport ID.

You may respond to my request(s) by either e-mail or postal mail at the following addresses:

My e-mail address is ________________________
OR
My postal address is ________________________________
________________________________________________
________________________________________________


Sincerely,




[your signature]
/html>