OHS Record Release Form
Requisition form for release of student information/records.

Odessa High School
713 S. 3rd Street
Odessa, MO 64076
PH: 816-633-5533 FAX: 816-633-7506
Registrar: Michelle Barker mbarker@odessar7.net

Student's Name
Your answer
Current Street Address
Your answer
City & State
Your answer
Zip Code
Your answer
Student's Email Address
Your answer
Date of Birth
MM
/
DD
/
YYYY
Graduation Year
Your answer
Maiden Name (if applicable)
Your answer
Telephone Number
Your answer
Type of Record Requested?
If "Other" was selected please describe.
Your answer
Where would like your records sent? (Check all that apply)
Required
If "Other" was selected please describe.
Your answer
Name of College/School/Agency
Your answer
Contact Person
Your answer
Street Address of School or Agency
Your answer
City, State & Zip Code
Your answer
Phone Number
Your answer
Fax Number
Your answer
Email Address (College/School/Agency Contact)
Your answer
How would you like these records sent?
Permission to Release
Required
Name of Requester
Your answer
Date of Request
MM
/
DD
/
YYYY
Submit
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