The undersigned hereby authorizes the Spirit Lake Community School District and any of its agents to release copies of the following official education records: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Concerning. _________________________________________________ _____________________________
(Legal Name of Student) (Date of Birth)
__________________________________________ _____________________________
(Name of Last School Attended) (Dates of Attendance)
The reason for this request is:______________________________________________________________________ ________________________________________________________________________________________________
Copies of the records shall be furnished to the following (check all that apply):
( ) the undersigned ( ) the student ( ) other pleasespecify:________________________________________________
The undersigned has the following relationship to the student: _______________________________________________
______________________________________ ___________________________________
(Signature) (Address)
_________________________________________ ___________________________________
(Printed Name) (City, State, Zip Code)
___________________________________ ____________________________
(Phone Number) (Date)
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Approved: |
Reviewed: 5/13/13; 6/10/19 |
Revised: 7/24/25 |