REQUEST FOR RELEASE FROM THE ALCORN SCHOOL DISTRICT

REQUEST FOR RELEASE FROM THE ALCORN SCHOOL DISTRICT
A separate form must be completed for each student for whom a request for release is made.

Please read carefully: This form must be filled out COMPLETELY. Incomplete, erroneous, or false information may result in the denial of your request or revocation of a request previously granted.
School Year Request Applies To*
Student Name*

First NameLast Name
Student Age*
School Last Attended In Spring Semester*
Grade*
Number of Years Attended*
Alcorn School District School of Residence*
School You Wish to Attend in the Fall semester*
Grade*
Reason for Request to Release*
Parent Name*

First NameLast Name
Parent Phone Number*
Parent Email Address*
example@example.com
911 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State*
Signature of Parent/Legal Guardian*

Clear
Should be Empty: