The undersigned hereby requests permission to examine and/or receive copies of the Spirit Lake Community School District's official education records of:
____________________________________ _____________________________
(Legal Name of Student) (Date of Birth)
The undersigned requests copies of the following official education records of the above student:
______________________________________________________________________________
______________________________________________________________________________
The undersigned certifies that they are (check one):
(a) An offical of another school system in which the student intends to enroll. ( )
(b) An authorized representative of the Comptroller General of the United States. ( )
(c) An authorized representative of the Secretary of the U.S. Department of Educagtion of U.S. Attorney General. ( )
(d) A state or local official to whom such is specifically allowed to be reported or disclosed. ( )
(e) A person connected with the student's application for, or receipt of, financial aid - specify details: __________________________________ ( )
(f) Otherwise authorized by law - specify details: __________________________________ ( )
(g) A representativce of a Juvenile Justice Agency with which the District has an interagency agreement. ( )
The undersigned agrees that the information obtained will only be re-disclosed consistent with state or federal law without the written permission of the parents of the student or the student if the student is of majority age.
_________________________________________________ ______________________________________
(Signature) (Title)
___________________________________________________
(Agency)
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Approved: |
Reviewed: 5/13/13; 6/10/19 |
Revised: 7/24/25 |