Kansas > Local District Court > 3rd Judicial District (Shawnee County) > Civil
Authorization For Release Of Education Records - Kansas
| Authorization For Release Of Education Records Form. This is a Kansas form and can be used in Civil 3rd Judicial District (Shawnee County) Local District Court . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
AUTHORIZATION FOR RELEASE OF EDUCATION RECORDS TO: This will authorize release to the firm of _____________________________ __________________________________________________________________________________ ______of any and all information in your possession, custody and/or control pe rtaining to the educationof the undersigned including but not limited to grades, attendance, disc ipline, extracurricularactivities, athletics, nursing or health records, graduation or certific ation. Such release of theforegoing shall be authorized upon presentation of this authorization or any duplicate orphotostatic copy thereof. Dated this ______ day of __________________________, 20_____. __________________________________ SIGNATURE Social Security No. _____ - ____ - ______ Date of Birth: _____/_____/_____STATE OF __________________ ) ) ss: COUNTY OF ________________) Subscribed and sworn to before me this ______ day of ___________________ __,20_____. _________________________________ Notary PublicMy Appointment Expires: _______________
|
|||||||
