AUTHORIZATION FOR RELEASE OF STUDENT RECORDS
|
The undersigned hereby authorizes
|
| |
|
|
School district to release copies of the following official student records:
|
| |
|
concerning
|
|
(Full Legal Name of Student)
|
|
|
(Date of Birth)
|
|
| |
|
|
(Name of Last School Attended)
|
|
(Year(s) of Attendance.) from 20 to 20
|
|
The reason for this request is:
|
|
| |
|
| |
| |
|
|
My relationship to the child is:
|
|
| |
|
|
Copies of the records to be released are to be furnished to:
|
|
( ) the undersigned
|
|
( ) the student
|
|
( ) other (please specify)
|
|
| |
|
|
Signature
|
|
|
Date
|
|
|
Address/City/State/ZIP/Phone Number
|
|
| |
|