• 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.

  • Student Information

  • 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.

  • Parental/Guardian Consent

  • 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