STUDENT PERSONNEL
Series 500
Policy Title: Authorization For Release of Education Records
Code No.: 558E2
The undersigned hereby authorizes the Carroll Community School District to release copies of the following official education records
________________________________________________________________________
________________________________________________________________________
concerning: ______________________________________________________________
(Full Legal Name of Student) (Date of Birth)
________________________________________________________________________(Name of Last School Attended)
From 20___ to 20___ (Year(s) of Attendance)_______
The reason for this request is: _______________________________________________
My relationship to the child is: ______________________________________________
Copies of the records to be released are to be furnished to:
( ) the undersigned
( ) the student
( ) other (please specify)___________________________________________________
____________________________________________
(Signature)
Date:__________________________
Address: _______________________
City: __________________________ State: _________________________
Zip: ___________________________ Phone Number: _________________
Date of Adoption/Review/Revision:
June 2017
December 2023
