Transcript Release Form | Lake City Public Schools

Release of Student Records Form

Name of Student (First, Middle, Last):

Birth Date:

Release Information To: ISD #813, Lake City, MN

Release Information From:

Check off all that apply:

All Records

Specific Records:

Educational records: name, address, birth date, grade level completed Attendance records Transcripts (GPA), report card, and list of courses in progress with withdrawal grades Health and Immunization records Current Athletic physical, if in sports Assessment information including MCA, ACT, NWEA, MAP, PSAT, etc…. Discipline records including suspensions and expulsion paperwork Special Education records (including but not limited to: Evaluations, IEP, 504 Plans, Psychological reports) Other information that may be helpful in admission or placement of this student

Date:

(Signature of student if 18 years of age)

(Signature of parent if student is a minor)

Contact Info

Superintendent’s Office
(651) 345-2198
300 South Garden Street
Lake City, MN 55041

Lincoln High School
(651) 345-4553
Fax: (651) 345-5894
300 South Garden Street
Lake City, MN 55041

Lincoln Attendance
(651) 345-4472

Bluff View Elementary
(651) 345-4551
Fax: (651) 345-2781
1156 West Lakewood Ave.
Lake City, MN 55041

Bluff View Attendance
(651) 345-4528

Activities Director
(651) 345-2850
300 South Garden Street

Community Education
(651) 345-7170
1156 West Lakewood Ave.

| Policies