Transcript Release Form | Lake City Public Schools

FROM:

To:

Guidance Office

Independent School District #813

Lake City, MN 55041

(Insert all names and addresses in whom information may be released.)

Please release my school records and activities including, but not limited to specific programs, grades, basic standards testing, graduation standards, class standing, attendance record, achievement, intelligence, aptitude, personality and interest test scores, health records, and other comments and recommendations regarding myself. Send I.E.P. and psychological assessments if in special education. The information being released is to be used by the person or institution to whom it is released to consider me for employment or admission to the above named institution(s). Release will expire twelve (12) months from this date.

Dated:

(Signature of student if 18 years of age)

(Signature of parent if student is a minor)