Authorization for Release of Records
This is an official request for a student's education records. The information contained in this request should be considered private. Please complete all information in full and then finalize your request by clicking 'SUBMIT'.

PLEASE NOTE: Education verifications do not require a signed release. In accordance with the Family Educational Rights and Privacy Act of 1974 and California State Law; CORE Butte Charter School will release and MAIL to the school named below the student records requested via this form.

Email address *
Requestor's Name *
Your name
Your answer
Place of Employment *
Your answer
Phone Number *
What is the best number to reach you at if we have questions?
Your answer
Reason for request *
Student Name *
Your answer
Name while attending CORE (if different)
Your answer
Birthdate *
MM
/
DD
/
YYYY
Grade *
Your answer
Student's First Date of Enrollment at Requestor's School *
What date did the student start attending, or what date do you anticipate the student to attend your school?
MM
/
DD
/
YYYY
Please release and mail the following records: *
Special education records include IEPs, ITPs, BIPs, academic assessments, speech & language assessments, psychological evaluations, and any other pertinent special education related information.
Required
Please Fax the following URGENT document ASAP
Your answer
Fax #
Your answer
Please mail documents to: School Name *
Your answer
Please mail documents to: School Address *
Your answer
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