To:
Address:
Board Secretary (Custodian)
The undersigned desires to examine the following official education records of:
_________________________________________ ____________________________
Full Legal Name of Student Date of Birth
_____________ ___________________________________________________________
Grade Name of School
My relationship to the student is:
Check one:
____I do desire a copy of such records.
____I do not desire a copy of such records.
I understand that a reasonable charge may be made for the copies.
___________________________________ ______________________________
Parent's Signature Date
___________________________________ ______________________________
Address Phone Number
_________________________________________________________________________
City, State, Zip
APPROVED:
___________________________________ ______________________________
Signature Title
___________________________________ ______________________________
Address Date
_________________________________________________________________________
City, State, Zip