School Records Request And Release Form printable pdf download

School Records Request And Release Form

SCHOOL RECORDS REQUEST AND RELEASE FORM

(Please submit this form to the school guidance department to retain in their files)

Please submit all records as soon as possible.

To the Guidance Department:

I hereby authorize school officials to release the following school records to Marist

Upward Bound on behalf of my child,

__________________________________________________________________.

(Print student’s name)

•

Transcript including final grades from the last three school years

•

Most recent report card for current school year

•

IEP report (only if applicable)

•

New York State Standardized test scores in English Language Arts (ELA)

and Mathematics taken to date

•

Attendance and Disciplinary reports

•

Progress and Quarterly report cards after program enrollment

Upon enrollment in Upward Bound, I authorize school officials to release

requested academic or personal information to Marist Upward Bound until all

graduation requirements are met. I also authorize Upward Bound to release similar

program information to other agencies conducting business with Upward Bound.

___________________________________________

Print Name

___________________________________________

_______________

Parent Signature

Date

School Records Request And Release Form