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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