506.01 E2 - Education Records Access - Authorization for Release of Education Records

AUTHORIZATION FOR RELEASE OF EDUCATION RECORDS

 

The undersigned hereby authorizes ____________________________________________

 

School District to release copies of the following official education records:

_____________________________________________________________________________________________________________

___________________________________________

concerning

_____________________________________   ____________________

              (Full Legal Name of Student)                        (Date of Birth)

 

____________________________________________________       from 20__ to 20___

                            (Name of Last School Attended)                              (Year(s) of Attendance)

 

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: _________________________

 

Approved: October 14, 2024

Reviewed: January 17, 2005; March 21, 2011; January 19, 2015; August 19, 2019; October 14, 2024

Revised: October 14, 2024