Oyster River Cooperative School District – SAU #5

Request for Release and/or Exchange of Student Information

Parent:	Student:
Address:	DOB:
	Current Grade:
Phone #:	SASID #:

The purpose of this authorization is to (check one):

Request information for a new student - first day at ORCSD was/will be ___________________

Release information for a student leaving ORCSD – last day was/will be___________________

Exchange/Release information regarding a current student

I hereby authorize Oyster River Cooperative School District to exchange, release, or request educational, psychological and medical information concerning my child with/from:
School/Agency:
Address:
Contact Name:
Phone #:	Fax #:

Authorizing Signature:______________________________________ Date: _________________

Printed Name:_______________________________ Relationship to Student ________________

For information requests, please send information/records to the school indicated below.

Mast Way School, 23 Mast Rd., Lee, NH 03861 (603) 659-3001

Moharimet, 11 Lee Rd., Madbury, NH 03823 (603) 742-2900

Oyster River Middle School, 1 Coe Dr., Durham, NH 03824 (603) 868-2155

Oyster River High School, 55 Coe Dr., Durham, NH 03824 (603) 868-2375

Date Request/Release sent_________________ Date Information Received_________________

It is the practice of Oyster River Cooperative School District to obtain parental authorization for the release and exchange of information so that parents and/or guardians of our students are aware of the sharing of information regarding their child. However, as per FERPA (34 CFR § 99.31), schools are allowed to disclose educational records of a student without written consent of the parent, guardian, or student when the disclosure is to other schools and school officials within the educational institution or legal educational agency who have been determined by the agency or institution to have legitimate educational interest.

A copy of this authorization shall be as valid as the original.