AUTHORIZATION TO
RELEASE SCHOOL RECORDS
In accordance
with the “Family Educational Rights and Privacy Act” the following school
record information may be released or reviewed as specified below:
I authorize
(Name of last school your
child attended)
(Street and/or PO Box)
(City) (State) (Zip Code)
to release confidential school record
information on
Birthdate: Grade SS# - -
Birthdate: Grade SS# - -
Birthdate: Grade SS# - -
(Name of Student/s)
as specified below:
□ School Record Information
□ Attendance
Record
□ Ability and achievement Tests
□ Grades and Class Rank
□ Health Information Physical Forms
□ Individualized Education Plan and Case
Study
This does not waiver the
right to challenge the content of these records by the parents, guardian,
emancipated minor or adult as prescribed by law.
Signed: Relationship to Student
Address: Date:
PLEASE
SEND RECORDS TO:
3303
Homer Adams Parkway