School Records Release Form "*" indicates required fields Student Name* First Middle Last Name of School Last Attended* Grade*Please enter a number from 1 to 12.School Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I agree to have the school release the following records* Cumulative records Transcript/report card/checkout grades Disciplinary records Special education records Immunization/health records Attendance Standardized tests Copies of birth certificate, social security card School Phone*School FaxAs the parent/guardian of the above named child, I grant my permission for the school listed above to release information to St. Joseph's Indian School, Chamberlain, SD; for the purpose of determining if my child should be admitted to St. Joseph's Indian School. I understand that this release is valid until it is revoked in writing by me. I also understand that the collection of this information does not mean my child has been admitted to St. Joseph's Indian School, but only that admission is being considered.Parent/Guardian Signature* Reset signature Signature locked. Reset to sign again Print Name of Parent/Guardian (2) Parent/Guardian Signature Reset signature Signature locked. Reset to sign again Print Name of Parent/Guardian Parent/Guardian Email* According to the Final Regulations-Family Educational Rights and Privacy Act (Buckley Amendment), June 17, 1976, it is no longer necessary to obtain consent to release records. It states that school officials of other schools in school systems in which the student may intend to enroll, may receive a student’s record without a written consent for such release.