Authorization for Release of Student Records
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Authorization for Release of Student Records
Student Name
*
required
First Name
Last Name
Student Date of Birth
Parent/Guardian Name
*
required
First Name
Last Name
Street Address
City, State
Zip Code
Telephone
Please include area code
Email Address
Records will be emailed by request only
Reason for this record request
Relationship to the student
Authorization
*
required
I authorize the release of student records
Date
*
required
Please note: The first copies of student records will be provided at no charge. Additional copies will be charged 25 cents per page.
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