2026 Debutante Ball AUTHORIZATION FOR RELEASE OF RECORDS FORM

Beta Omega Chapter

2026 Debutante Ball
AUTHORIZATION FOR RELEASE OF RECORDS FORM
Directions: The applicant’s parent or guardian must complete and sign the Release Form for the release of records of the school’s Official Transcript of the applicant.
Date*

MonthDayYear
Today's Date
Student Name*
Student Birth Date*

MonthDayYear
Date
Student #*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Telephone*
Please enter a valid phone number.
Mobile Telephone*
Please enter a valid phone number.
Current High School*
Previous High School attended
I First Name* Last Name* , the parent or guardian of the above student, authorize a release of records: Diagnostic Summary, IEP, and any other pertinent special educational information to the following individual:

Ms. Dominique Campbell, Co-Chairman

Screening and Awards

Alpha Kappa Alpha Sorority, Incorporated® Beta Omega Chapter
Name of parent or guardian signing *
Signature of parent or guardian*

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Address of parent or guardian*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email of parent or guardian*
example@example.com
Daytime Telephone number of parent or guardian. *
Please enter a valid phone number.
Evening number of parent or guardian.
Please enter a valid phone number.
This form must be submitted electronically through JotForm by Monday, April 13, 2026
Should be Empty:

Beta Omega Chapter