SOUTH SANPETE SCHOOL DISTRICT AUTHORIZATION OF RELEASE SCHOOL RECORDS
I hereby authorize the release of student records, documents, or other information concerning
____________________________________________________________ (student). DOB: _______________________
to _________________________________________________________________________________________(person receiving records).
This release covers all school records, including but not limited to, records pertaining to discipline, expulsions, suspensions, attendance, grades, transcripts, testing results and special education.
A copy of this Authorization shall be as valid as the original and maintained in the student’s file. This authorization is effective immediately and expires one year from the date below unless a written request is submitted.
Dated: _________________________________________________
Signature: ________________________________________________
Print full name: ____________________________________________________ Relationship to student: ______________________________________
Phone number: ___________________________________________________
