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