Hereford Independent School District Hereford, TX 79045 Student Information Release This form is in compliance with FERPA 34 CFR Part 99, 99.31 (a)(2) and 99.34 PARENT SIGNAUTRE NOT REQUIRED. Office use only: 1 st request- 2 nd request- 3 rd request - TO: Phone: Fax: Email: You are hereby authorized to release all school records concerning the following student(s): Student Grade Birthdate Student Grade Birthdate Student Grade Birthdate Student Grade Birthdate 1. Standardized Test Data 4. Psychological Data 2. Scholastic Achievement Date (credits, grades, etc.) 5. Sociological Data 3. Medical Data 6. Individualized Testing Data PLEASE ADVISE OF ANY SPECIAL CLASS PLACEMENT USED. If a student left before the close of the term, please include the grades to date of withdrawal. Please forward records to the receiving school checked below: Signature of Student Services Specialist Date ☐ Aikman Primary 900 Ave K Phone: 806-363-7640 ☐ Bluebonnet Intermediate 221 16 th St Phone: 806-363-7650 ☐ Northwest Primary 400 Moreman Phone: 806-363-7660 ☐ West Central Intermediate 120 Campbell Phone: 806-363-7690 ☐ Tierra Blanca Primary 615 Columbia Drive Phone: 806-363-7680 ☐ Stanton Learning Center 711 E. Park Ave Phone: 806-363-7610 ☐ Hereford Junior High 704 LaPlata STE A Phone: 806-363-7630 ☐ Hereford Preparatory Academy 704 LaPlata STE B Phone: 806-363-7740 ☐ Hereford High School 200 Ave F Phone: 806-363-7620 ☐ H-CAL 239 Ave F Phone: 806-363-7720 ☐ Hereford Independent School District Student Records Department 601 N 25 Mile Ave Phone: 806-363-7600 Fax: 806-363-7699 Enrollment Date Enrollment Date Enrollment Date Enrollment Date Peoria Elmentary School Leanna Irene McAllister st1 03/27/2010 303-326-1235 05/16/2017 303-340-0770 Please send shot record asap!! 05/15/2017

Office use only: Hereford Independent School District 1 ... Independent School District Hereford, TX 79045 2 Student Information Release This form is in compliance with FERPA 34 CFR

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HerefordIndependentSchoolDistrictHereford,TX79045

StudentInformationRelease

ThisformisincompliancewithFERPA34CFRPart99,99.31(a)(2)and99.34PARENTSIGNAUTRENOTREQUIRED.

Officeuseonly:1strequest-2ndrequest-3rdrequest-

TO: Phone:Fax:Email:

Youareherebyauthorizedtoreleaseallschoolrecordsconcerningthefollowingstudent(s):Student Grade BirthdateStudent Grade BirthdateStudent Grade BirthdateStudent Grade Birthdate

1.StandardizedTestData 4.PsychologicalData2.ScholasticAchievementDate(credits,grades,etc.) 5.SociologicalData3.MedicalData 6.IndividualizedTestingData

PLEASEADVISEOFANYSPECIALCLASSPLACEMENTUSED.

Ifastudentleftbeforethecloseoftheterm,pleaseincludethegradestodateofwithdrawal.

Pleaseforwardrecordstothereceivingschoolcheckedbelow:

SignatureofStudentServicesSpecialist Date

☐AikmanPrimary 900AveKPhone:806-363-7640 ☐BluebonnetIntermediate22116thStPhone:806-363-7650 ☐NorthwestPrimary400MoremanPhone:806-363-7660☐WestCentralIntermediate120CampbellPhone:806-363-7690

☐TierraBlancaPrimary615ColumbiaDrivePhone:806-363-7680 ☐StantonLearningCenter711E.ParkAvePhone:806-363-7610 ☐HerefordJuniorHigh704LaPlataSTEAPhone:806-363-7630☐HerefordPreparatoryAcademy704LaPlataSTEBPhone:806-363-7740

☐HerefordHighSchool200AveFPhone:806-363-7620☐H-CAL239AveFPhone:806-363-7720☐HerefordIndependentSchoolDistrictStudentRecordsDepartment601N25MileAvePhone:806-363-7600Fax:806-363-7699

Enrollment Date

Peoria Elmentary School

Leanna Irene McAllister st1 03/27/2010

303-326-1235

05/16/2017

303-340-0770

Please send shot record asap!!

05/15/2017