Family Education Rights & Privacy Act Educational Records Release Form for Hearing/Vision Screening
The Forrest City School District performs vision and hearing screenings on Kg, 1st, 2nd, 4th, 6th, 8th grades,
transfer students and students being referred or reevaluated for IDEA or 504 purposes each year as
required by Arkansas law. You are notified if your child does not pass the screening. By providing the
requested information below, the District may be reimbursed by Medicaid/AR Kids. Your consideration
and response is appreciated. Please return the completed form to your child's school.
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This form was created inside of Forrest City School District.