25-26 Special Education Records Request Form

25-26 Special Education Records 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.... Parent

Other

Name of School/Agency Requesting Records

Requestor's Name

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

Area CodePhone Number
Name of your School or Relationship to Student
Reason for Request
For which school year is the request?

Student's Name

First NameLast Name
Student's Date of Birth

MonthDayYear
Date
Student's Grade Level
Student's First Day of Enrollment with your School

MonthDayYear
Date

Please Release and Mail the Following Records
Are Any Records Needed Urgently

Which Items are Needed Urgently?

How Would you Like to Receive the Records?

Email Records to:
example@example.com
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

Requestors Name:

First NameLast Name
Please Sign Here

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