Mansfield Independent School District - Parents/students Educational Records Request

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MANSFIELD INDEPENDENT SCHOOL DISTRICT
~Parents/Students Educational Records Request~
Records Requested For:
Student’s Full Name:
Student ID # or Last 4 digits of SS #:
Student’s Date of Birth:
Year Graduated (if applicable):
Date Rec’d/Released
Date Rec’d/Released
 Official
Transcript of Grades
Enrollment form(s)
 Unofficial
(i.e. report cards/transcripts)
Birth certificate copy
Social security card copy
Attendance records
Immunization records
Health/medical records
Assessment/test results
Behavior/discipline records
504 records (if applicable)
rd
3
party requests
Other (please specify)
Send/release records as indicated below by completion of information:
US Mail: Name, address, city/zip
Date mailed:
Parent/student pick up
Date of pick up:
E-mail: Address
Date emailed:
Picture identification copied if possible and signatures are required for all requests.
Parents may view or request records for students who are age 18 or older without consent of the adult student if the parent
provides the school with evidence that the eligible student is a dependent per 34 CFR Sec. 99.31(a)(8).
If records are requested for a current or prior student age 18 or older, the student must give written authorization in order for the
MISD to release records/confidential information.
Graduates or students who are no longer enrolled in MISD can obtain a transcript for a $2.00 fee. Current students may receive up
to 10 transcripts at no cost and $2.00 per transcript for additional requests.
Signature of Parent/Guardian, Student, or Adult Student: _______________________________________________*
*By signing above, I give permission for the release of records / confidential information to the party named above, and for the MISD to consult with the
party named above, as required to meet the needs of the student for whom the request was originally made.
***********************************For Office Use Only***********************************
 Photo ID verified
 Cum Folder Checked for Legal Documentation that May Restrict Access (i.e. Court Order)
Information collected by:
Date:
PRINT NAME(S)
Information released/approved by:
Date:
PRINT NAME
Principal or AP
Revised 8/12/2015

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