Current & Previous School
Student Records Request Authorization
This form is to be used by the eligible parent/legal guardian or eligible student (age 18) to request the release of student information. Please note that the previous school from which the records will be requested may also require you to sign an authorization form.
As the parent or legal guardian, I hereby authorize Easterseals Academy to submit a student records request to the school listed below, in order to obtain educational records (if necessary). This authorization may be revoked at any time by providing a written/signed statement to Easterseals Academy.
My signature below affirms that all of the information contained in this application is correct, complete, and honestly presented. I understand that withholding or misrepresenting information in this application may jeopardize my child's admission.