General Education

General Education

Authorization for Release of Student Records
This is an official request for a student's educational record. The information contained in this request should be considered private. Please complete all fields below then finalize by clicking "Submit".

PLEASE NOTE: In accordance with the Family Educational Rights and Privacy Act of 1974 and California State Law, Granite Mountain Charter School will only release the requested student's records to the school or parent/guardian named on this form.
I am a.... *

School/Agency Requesting Records Parent/Guardian Requesting Copies of Student Records
Requestor's Name *

First Name Last Name
Requestor's Email *
example@example.com
Requestor's Phone Number *

Area Code Phone Number
Name of your School or Place of Employment *
Reason for Request *

New School of Attendance Other
Student's Name *

First Name Last Name
Student's Date of Birth *

Month Day Year
Date
Student's Grade Level *
Student's First Day of Enrollment with your School *

Month Day Year
Date

Please Release and Mail the Following Records *

Latest Report Card (If Available) State Test Scores (CAASPP) CELDT/ELPAC Scores Immunization/Waiver Enrollment Documents Entire, Cumulative Record Other
Are Any Records Needed Urgently *

Yes No

Which Items are Needed Urgently? *

Latest Report Card (If Available) State Test Scores (CAASPP) CELDT/ELPAC Scores Immunization/Waiver Enrollment Documents Other
Please fax/email records to: *

Educational Institute Authorization

I hereby certify and verify that the named student is requesting enrollment in our school and my signature below authorizes Granite Mountain Charter School to forward the requested records for educational use only. I understand the recipient of the record/s will use said document/s for legitimate interests only and the information contained therein shall not be further transferred or communicated to any other party or agency without the expressed, written consent of the current/former student except under the authority of Public Law 93-380, Educational Rights and Privacy Act. By clicking "Submit", I certify this information to be complete and accurate. I declare under penalty of perjury the foregoing is true and correct.
Position/Job Title *
Requestor's Signature *

Clear

Parents requesting copies of their student's records should email:

records@granitemountainschool.com

Thank you!
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Educational Institute Authorization