506.1E2 - AUTHORIZATION FOR RELEASE OF EDUCATION RECORDS

AUTHORIZATION FOR RELEASE OF EDUCATION RECORDS

Code No.  506.1E2

 

 

 

 

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:

 

 

                                           

Reviewed 04/22/2024

Revised: