20 11 SCHOOL RECORDS AUTHORIZATION

• Jurisdiction: Arkansas
• Library: Arkansas Form Book - Complete (2023 Ed.)

20-11 SCHOOL RECORDS AUTHORIZATION

RECORDS RELEASE FORMAUTHORIZATION TO RELEASE STUDENT INFORMATION AS PER H.R. 69, PUBLIC LAW 92-380, SEC. 433 OF THE UNITED STATES CODE "PROTECTION OF THE RIGHTS AND PRIVACY OF PARENTS AND STUDENTS"

To: [school name]

Name of Student: [student name]

Date of Birth: [birth date]

Social Security Number: [Social Security number]

Years of Attendance: [years attended]

Please mail records to: [Attorney]
[Law Firm]
[Address]

Registrar or Counselor:

You are hereby authorized to...