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SPARTA TOWNSHIP PUBLIC SCHOOLS |
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RELEASE OF RECORDS FORM |
Permission is hereby granted to: |
Previous School Name |
________________________________________________ |
Address |
________________________________________________ |
|
________________________________________________ |
Student Name |
__________________________________ Grade _______ |
The above named student has registered at (name of school): ______________________
Please release the following information:
•Grades
•Health records
•Results of achievement and intelligence tests
•Personality rating and other similar data
•Grades in progress at time of leaving
•Any other material pertinent to the growth of the student
•Any psychological testing or Child Study Team information, including the most recent: O Educational Evaluation
O Psychological Assessment
OSocial worker history
Written information is to be sent to the attention of:
(School) _____________________________________________________
Address: _____________________________________________________
City, State, Zip ____________________________________________________
Authorization to release pupil’s records:
I have enrolled my child __________________________________ ________________
NameDate of birth
in the ______________________________________ and authorize you to release the
(New School)
above named information so that we may plan a program for this student.
Signature of Parent of Guardian __________________________________ Date _______