General Education Cume Release

General Education Cume Release

Authorization for Release of Records
This is an official request for a student's educational records. The information contained in this request should be considered private. Please complete all the information in full and then finalize your request by clicking 'Submit'.

PLEASE NOTE: In accordance with the Family Educational Rights and Privacy Act of 1974 and California State Law, The Cottonwood School will release to the school named below the student's records requested via this form.
I am a......*

School/Agency Requesting RecordsParent Requesting Copies of Records and/or School Official Requesting Transcripts
Requestor's Name*

First NameLast Name
Requestor's Email*
example@example.com
Requestor's Phone Number*
Please enter a valid phone number.
Name of your School or Place of Employment*
Reason for Request*

New School of Attendance - Immediate EnrollmentNew School of Attendance - School Year 21/22Other
Student's Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Date
Student's Grade Level*
Student's First Date of Enrollment at Your School

MonthDayYear
Date
Please release and mail the following records*

Latest Report CardState TestingCELDT/ELPAC ScoresImmunization/WaiverEnrollment DocumentsEntire Cumulative RecordOther
Are any records needed urgently?*

YesNo
What items are needed urgently?

Latest Report CardState TestingCELDT ScoresImmunization/WaiverEnrollment DocumentsOther
Please fax/email urgent records to*
How would you like to receive the records*

MailedEmailed Only
If Mailed, Please send Documents ATTN to:

First NameLast Name
Please Mail Documents to This Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Institute Authorization
I hereby certify and verify that the named student is requesting enrollment in our school and that my signature below authorizes The Cottonwood School to forward the records for educational use only. I understand that the recipient of the record(s) will use said documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other part or agency without the expressed written consent of the current/former student except under authority of Public Law 93-380, Educational Rights and Privacy Act. By clicking 'SUBMIT', I certify this information as complete and accurate.

I declare under penalty of perjury that the foregoing is true and correct.
Position/Job Title:*
Requestor's Signature*

Clear
Parents or School Officials requesting copies of their student's records/transcripts, follow this link:
https://script.google.com/a/macros/cottonwoodk12.org/s/AKfycbzPfSdWV_Vdaz8eu9NtRbgGgvUZT23qgS4gqGhVLZ1e2PqhsDc/exec?action=sign&formId=1q8HPIR-T8Sc-L7B3_M5yaePzHFuLlstxEgykAZweKsg&editorUUID=daafc5fd-f2c7-4571-b7de-bb2de1bd0fc5
Thank you!
Should be Empty:

General Education Cume Release

Educational Institute Authorization

Parents or School Officials requesting copies of their student's records/transcripts, follow this link:

Thank you!