The undersigned hereby requests permission to examine and/or receive copies of the Spirit Lake 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 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 District may charge me a reasonable fee for copies.
( ) does not want copies of the above-stated student records.
___________________________________ ___________________________________
(Signature) (Printed Name)
Approved: ________ Signature ___________________________________ Title _____________________________
Date: ____________. Address: _______________________________________________________________________
City: __________________________________ State _____________________________ Zip Code ________________
Phone Number: _____________________________________________________
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Approved: Reviewed: 5/13/13; 6/10/19 Revised: 7/14/25