Sub – [Student Name whose records are being required]
Date of Birth – [….]
Social Security Number – […..]
To: [Name of the Registrar]
I/we hereby give our approval to [party name] or their representative to scrutinize, examine and make copies of all the records representing grades, attendance, involvement in supplementary activities, and other personal records relating to student [student name] from his/her date of admission at [school name] till date.
Copies of this authorization are to be considered as valid as the original.
If the student is above 18 years old, use this signature block:
Dated: _______________
_____________________________________
Student sign
_____________________________________
Student name (please print)
In case student is a minor, use this signature block:
Dated: _______________
_____________________________________
Signature of parent or guardian
_____________________________________
Parent or guardian’s name (please print)
Download Sample Authorization to Release School Records Letter In Word Format
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