request for release or transfer for school records - Our Lady of Sorrows
request for release or transfer for school records - Our Lady of Sorrows
request for release or transfer for school records - Our Lady of Sorrows
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REQUEST FOR RELEASE OR TRANSFER FOR SCHOOL RECORDS<br />
This <strong>f<strong>or</strong></strong>m is provided <strong>f<strong>or</strong></strong> the purpose <strong>of</strong> obtaining <strong>or</strong> releasing a student’s rec<strong>or</strong>ds. By signing this<br />
<strong>release</strong>, a parent <strong>or</strong> legal guardian will expedite the <strong>transfer</strong> <strong>of</strong> rec<strong>or</strong>ds to the receiving <strong>school</strong>.<br />
OFFICIAL REQUEST FOR INFORMATION: (Please print <strong>or</strong> type)<br />
STUDENT__________________________BIRTHDATE________GRADE_____ENTRY DATE_________<br />
STREET ADDRESS____________________________________________________________________<br />
CITY_______________________________________STATE______________ZIP____________<br />
PREVIOUS SCHOOL___________________________________________________________________<br />
STREET ADDRESS____________________________________________________________________<br />
CITY______________________________________STATE____________ZIP_______________<br />
PURPOSE OF REQUEST<br />
Transfer_________ Other___________<br />
INFORMATION TO BE RELEASED<br />
_X_GENERAL EDUCATION RECORDS Should include: all grades at time <strong>of</strong> <strong>transfer</strong>, attendance, immunization,<br />
health rec<strong>or</strong>ds, standardized testing<br />
_X_SPECIAL EDUCATION/CONFIDENTIAL RECORDS Should include: medical, psychiatric, psychological, social<br />
hist<strong>or</strong>y, social w<strong>or</strong>k rep<strong>or</strong>ts, MET, IEPC rec<strong>or</strong>ds, etc.<br />
_X_ INFORMATION regarding any attendance in Special Education Programs <strong>or</strong> adjustment <strong>of</strong> curriculum <strong>f<strong>or</strong></strong><br />
any reason<br />
AUTHORIZATION FOR THE RELEASE OF STUDENT RECORDS<br />
In acc<strong>or</strong>dance with the provisions <strong>of</strong> the Family Education Rights and Privacy Act (PL93-380) I do hereby give<br />
consent to <strong>school</strong> indicated above (previous <strong>school</strong>) to <strong>release</strong> the above indicated rec<strong>or</strong>ds <strong>of</strong> this student to:<br />
OUR LADY OF SORROWS SCHOOL<br />
24040 Raphael Street<br />
Farmington, MI 48336<br />
Signature <strong>of</strong> Parent/Guardian<br />
Date
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