Student Services Records or Information Request Form Posted 11:26 AM by Amber Woods The Federal Family Educational Rights and Privacy Act (FERPA), and Arizona Law, provide that the written consent of the parent/guardian/eligible student IS NOT REQUIRED to release educational records to officials of other schools or school system in which the student seeks or intends to enroll. Written consent IS REQUIRED of a parent/guardian/eligible student when a request for student records involves non-school individuals, agencies, or institutions.Date of Request(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920STUDENT RECORDS / INFORMATION ARE REQUESTED FOR:Student record information is requested for use in providing appropriate educational services, and programs. We are requesting records/information on the following student:Student's Name(Required) First Last Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade Level(Required)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeRECORDS / INFORMATION IS REQUESTED FROM:RECORDS / INFORMATION IS REQUESTED FROM:(Required) School Agency or Non-school Individual Title/Position School(Required)SelectAnza Trail SchoolCopper View Elementary SchoolEarly Childhood CenterSahuarita Digital Pathways AcademySahuarita High School SchoolSahuarita Intermediate SchoolSahuarita Middle SchoolSahuarita Primary SchoolSopori Elementary SchoolWalden Grove High SchoolWrightson Ridge SchoolAddress(Required) Address City State ZIP / Postal Code PhoneFaxTYPE OF INFORMATION REQUESTED:(Required) Special Education Records – (Include IEP, ELL, Gifted, Psych. Evaluation, Speech Evaluation, OT/PT Evaluations, MET Report, Eligibility Form, Placement Statement) Permanent Record Data Health Data General Cumulative Data English Proficiency Records (include most current assessment results, and any withdrawal/reclassification notices) Verbal Communication between non-school individual/agency. (Only designated staff or Administrator may request verbal communication with non-school individual/agency per parent written consent indicated below) Specialized Student Data – including reports from other agencies RECORDS / INFORMATION ARE TO BE RELEASED TO:Name(Required) First Last Title/Position(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code FaxWRITTEN CONSENTRequired if records/information requested or released involve non-school individuals, agencies, or institutions.Select one(Required) Not applicable - Educational records are being released to school system in which student intends to enroll or has enrolled. I give consent to the release of indicated records/information to the individual/party listed above. I give consent for Verbal Communication between non-school individual/agency and school official as indicated above, for: I give consent for Verbal Communication between non-school individual/agency and school official as indicated above, for:(Required) the purpose of (i.e.; continuity of care) through (date) Parent/Guardian Signature(Required) Δ
