Student Record Request Form for Students and Parents
The undersigned hereby requests permission to examine and/or receive copies of the Interstate 35 Community School District's official student records of:
_________________________________________ ______________________________
(Legal Name of Student) (Date of Birth)
The undersigned requests to examine and/or receive copies of the following official student records of the above student:
The undersigned requests to examine and/or receive copies of the following official student records of the above student:
___________________________________________________________________________
___________________________________________________________________________
The undersigned certifies that they are the parent and/or legal guardian or of the above student or that they are the above student.
The undersigned (check one):
( ) does want copies of the above-stated student records. I understand that the school district may charge me a reasonable fee for copies.
( ) does not want copies of the above-stated student records.
_________________________________ (Signature)
_________________________________ (Printed Name)
_________________________________(Date)
_________________________________(Address)
_________________________________(City)
_________________________________(State, Zip)
_________________________________(Phone)
Approved:
__________________________________(Signature)
__________________________________(Title)
__________________________________(Date)