High School Request for Release of Student Records

Request for Release of Student Records

Berne Union High School
Please note in order to process a request for release of all records, you will need to provide us with a copy of the following:

Social Security Card

Birth Certificate

Custody Papers (if applicable)

Parent's Driver's License

Proof of Residency

Please bring them in to the High School office to complete this request.
School's Name (who are we requesting records from)
School's Address

Street Address

Street Address Line 2

City/StateState / Province

Postal / Zip Code
School's Phone #:
Format: (000) 000-0000.
School's Fax #:
Student's Name:

First NameMiddle InitialLast Name
Grade:
Date of Birth

MonthDayYear
Date
By signing below, I give my permission for the school listed above to release the requested information from my child's school record.
Parent / Guardian Signature:
Date

MonthDayYear
Date
Parent / Guardian Name:
Full Name
Should be Empty: