Authorization to release school records

Re: <name of employee whose records are being sought>
Date of Birth: <date of birth of employee>
Social Security Number: <social security number>

To: <registrar name>

<I/We> hereby authorize <name of party or parties to acquire employment records> or their agent or representative, to inspect, review and make copies, including photostatic copies, of all records indicating grades, attendance, participation in extra-curricular activities, and all other personal records pertaining to student <name of student> from the date of <his/her> first enrollment at <name of school> to the present date. Photostatic copies of this authorization will be considered as valid as the original.

If student is over the age of 18 years, use this signature block:,

Dated: _______________

_____________________________________
Student signature

_____________________________________
Student name (please print)

If student is still a minor, use this signature block:

Dated: _______________

_____________________________________
Signature of parent or guardian

_____________________________________
Parent or guardian’s name (please print)

Download authorization to release school records In Word Format

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