HerefordIndependentSchoolDistrictHereford,TX79045

StudentInformationRelease

ThisformisincompliancewithFERPA34CFRPart99,99.31(a)(2)and99.34PARENTSIGNAUTRENOTREQUIRED.

Officeuseonly:1strequest-2ndrequest-3rdrequest-

TO: Phone:Fax:Email:

Youareherebyauthorizedtoreleaseallschoolrecordsconcerningthefollowingstudent(s):Student Grade BirthdateStudent Grade BirthdateStudent Grade BirthdateStudent Grade Birthdate

1.StandardizedTestData 4.PsychologicalData2.ScholasticAchievementDate(credits,grades,etc.) 5.SociologicalData3.MedicalData 6.IndividualizedTestingData

PLEASEADVISEOFANYSPECIALCLASSPLACEMENTUSED.

Ifastudentleftbeforethecloseoftheterm,pleaseincludethegradestodateofwithdrawal.

Pleaseforwardrecordstothereceivingschoolcheckedbelow:

SignatureofStudentServicesSpecialist Date

☐AikmanPrimary 900AveKPhone:806-363-7640 ☐BluebonnetIntermediate22116thStPhone:806-363-7650 ☐NorthwestPrimary400MoremanPhone:806-363-7660☐WestCentralIntermediate120CampbellPhone:806-363-7690

☐TierraBlancaPrimary615ColumbiaDrivePhone:806-363-7680 ☐StantonLearningCenter711E.ParkAvePhone:806-363-7610 ☐HerefordJuniorHigh704LaPlataSTEAPhone:806-363-7630☐HerefordPreparatoryAcademy704LaPlataSTEBPhone:806-363-7740

☐HerefordHighSchool200AveFPhone:806-363-7620☐H-CAL239AveFPhone:806-363-7720☐HerefordIndependentSchoolDistrictStudentRecordsDepartment601N25MileAvePhone:806-363-7600Fax:806-363-7699

Enrollment Date

Enrollment Date

Enrollment Date

Enrollment Date

Peoria Elmentary School

Leanna Irene McAllister st1 03/27/2010

303-326-1235

05/16/2017

303-340-0770

Please send shot record asap!!

05/15/2017