To: ___________________________________ __________________________________
Board Secretary (Custodian) Address
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:____________________________________
Please check one:
( ) I Do
( ) I Do Not
desire a copy of such records. I understand that a reasonable charge may be made for the copies.
________________________________________
Parent’s Signature
Approved: __________________________________ Date:_________________________
Signiture____________________________________ City:________________________
Title:_______________________________________ State:_____________ Zip:_______
Dated:______________________________________ Phone:_______________________
UPLOAD FORM