Special Education Request Form

Special Education

Authorization for Release of Student Records
This is an official request for a student's special 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 RecordsThird Party RequestorParent/Guardian Requesting Copies of Student Records

Which Items are Needed Urgently?*

IEPOther
What other Items would you like to be sent?
Please fax/email records to:*
Please Mail Documents Attention to:*

First NameLast Name
Please Mail Documents to the Following Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational/Third Party 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
Please upload your authorization form signed by the parent/legal guardian.*

Browse Files

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

records@granitemountainschool.com

Thank you!
Should be Empty:

Special Education