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The undersigned hereby authorizes |
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School district to release copies of the following official education records: |
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concerning |
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(Full Legal Name of Student) |
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(Name of Last School Attended) |
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The reason for this request is: |
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My relationship to the child is: |
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Copies of the records to be released are to be furnished to: |
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( ) the undersigned |
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( ) the student |
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( ) other (please specify) |
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(Signature) |
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Date: |
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Address: |
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City: |
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State: |
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ZIP |
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Phone Number: |
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