506.1E3 Authorization for Release of Student Records

POSTED: July 25, 2024

Code No.  506.1E3 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)
from 20          to 20        
(Name of Last School Attended) (Year(s) of Attend.)
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:

 

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