Educational Support Records Release Form
Please complete this form to authorize the release of educational support records.
Full Name of Student
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
School Name
*
Parent/Guardian Name
*
First Name
Last Name
Relationship to Student
*
Please Select
Parent
Guardian
Self
Other
Records to be Released
*
Reason for Release
*
Signature of Parent/Guardian
*
Date of Authorization
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: