Release of Student Records Form
Use this form to request student records from a previous school district for a newly registered student.
Student First Name *
Student Last Name *
Date of Birth *
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Previous School Name
Grade *
School Contact Name *
School Street/Mailing Address *
School City
School State *
School Contact Phone Number *
School Contact Fax Number
School Contact Email
While enrolled at the above-mentioned school, my child received the following services:
Signed (electronically) by *
By signing your name electronically below you affirm that you are the legal guardian of the above student and authorized to give consent.
Date Completed *
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Submit
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