School Release of Information Form
Authorize the release of student records or information to a designated recipient.
Student Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Recipient Name
*
First Name
Last Name
Recipient Relationship to Student
*
Recipient Contact Information (Email or Phone)
*
Description of Records or Information to be Released
*
Reason for Release
Parent/Guardian or Student Name (if 18 or older)
*
First Name
Last Name
Date of Authorization
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: