Authorization to Release School Records

DOHN COMMUNITY HIGH SCHOOL
608 East McMillan Street Cincinnati, Ohio 45206
Telephone: 513 281-6100 Fax: 513 281-6103
 
Authorization to Release School Records
 
 
______________________________(Name of Parent) authorizes the release of the school records of the following student:
 
__________________________________  ___________________________  _______________________  _______________________
Last Name of Student                               First Name                        Middle Name                      Date of Birth
 
From:
 
Name of School_______________________________________________________________________________
 
Address:________________________________________ City, State, & Zip Code:_____________________________________
 
Telephone Number:______________________________                                        
 
Records may be released to:
                Dohn Community High School, Attn: A. Allen
                608 East McMillan Street
                Cincinnati, OH 45208                                Telephone: 513 281-6100            Fax: 513 281-6103
 
My signature authorizes the release of the following records: (Must check items 1, 3, 5, 6 & 7)
 
(1)_____ Transcript of subjects, grades & test records                     
(2)_____ IEP (Individual Education Plan)
(3)_____ Attendance records                                                
(4)_____ ETR (Evaluation Team Report (must be sent with all IEPs)
(5)_____ Health & immunization records                              
(6)_____ Psychological and/or educational testing
(7)_____ Discipline records (including suspensions & expulsions)        
 
 
___________________________________________________________                                          _________________________             
Signature of Parent/Legal Guardian                                                                                                  Date
 
 
If your policy is to hold student records if fees are owed, please send, as required by law, all special education records (IEPs and ETRs) and Ohio Graduation Test results.
Your cooperation is appreciated.