Request for Release from Clinton City Schools 2021-2022
Email address *
REQUEST
STUDENT'S FIRST NAME *
STUDENT'S MIDDLE NAME
STUDENT'S LAST NAME *
IN WHAT SCHOOL DISTRICT IS YOUR CHILD CURRENTLY ENROLLED? *
IF YOU CHECKED OTHER IN THE ABOVE QUESTION PLEASE STATE DISTRICT YOU RESIDE.
WHAT SCHOOL DOES YOUR CHILD ATTEND? *
WHAT SCHOOL SHOULD YOUR CHILD ATTEND?
PARENT/GUARDIAN'S FIRST NAME *
PARENT/GUARDIAN'S LAST NAME *
MAILING ADDRESS *
CITY, STATE, ZIP CODE *
RESIDENCE ADDRESS (IF DIFFERENT FROM MAILING ADDRESS)
PARENT/GUARDIAN'S CELL PHONE NUMBER *
PARENT/GUARDIAN'S WORK NUMBER
REASON FOR REQUEST *
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