Code No. 506.1E2
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: