CLICK HERE TO DOWNLOAD PARENTAL AUTHORIZATION FOR RELEASE OF EDUCATION RECORDS
The undersigned hereby authorizes the Linn-Mar 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) ________________________ (Years of attendance/From/To) ________________
The reason for this request is: __________________________________________________________________________________
My relationship to the child is: ___________________________________________________________________________________
Copies of the records to be release are to be furnished to:
_____ The undersigned
_____ The student
_____ Other (Specify: _______________________________________________)
Signature: ___________________________________ Date: _________________
Address: ___________________________________________________________
City: ____________________________ State: _________ Zip: ________________
Phone Number: ______________________________________________________
Adopted: 9/98
Reviewed: 7/13; 10/14; 12/20; 10/23
Revised: 8/17
Related Policy: 505.6; 505.6-R; 505.6-E2; 505.6-E4-E7
IASB Reference: 506.01-E(2)