School Record Release

Please complete the following form so that once the applicant has been accepted to New Hope Vision Academy we can request his/her records from his/her previous school. School Records Release

Name of Student

Grade of Student

I grant permission to the proper authorities at:

( Name and address of applicant’s current school )

to release a copy of this student's records to New Hope Vision Academy. Those records may include any or all of the following:

*Attendance Records
*Immunization Records
*Grades  Standardized Achievement Test scores
*IEP or 504 Plan
*Intelligence and aptitude test scores
*Teacher and/or counselor observations and comments
*Family background data
*Other information records

Signature of parent or guardian

Date