Section 10.64.F.1 - Student Education Records Request
This form is used to request student education records for students attending or who have attended Dysart Unified School District schools. Please complete the information requested below. A signature is required.
ASSURANCE STATEMENT AND SIGNATURES
In making this request, the undersigned agrees that the information received will be used only by the professional school staff members who are assigned to work with the student in the educational program and will not be released to any other party without the prior written consent of the parent or eligible student.
I, ___________________________, as the parent/guardian of __________________________, consent to the release of records listed above to the party named above. I am aware of my rights to review the records and receive a copy at my expense, if I so request.
Date Requested Authorized Signature
Reference: Section 10.64, Form 10.64.F.1