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Request for Exchange of Confidential Information.pdf
Handle: Document-107860
Owner: Geveshausen, Olivia (User-6386, 15414:EVERETT)DS
Friday, August 23, 2019 02:43:30 PM PDT
Thursday, November 18, 2021 12:47:32 PM PST
Modified By: Diaz, Ailienette (User-392, 08810:EVERETT)DS
Locked By:
  • Student Support Services Department
PO Box 2098Everett, WA 98213www.everettsd.orgREQUEST FOR EXCHANGE OF CONFIDENTIALEDUCATIONAL INFORMATIONDate:Student Name: Student ID: Birthdate:Requestor: Name: School: Grade:I hereby authorize the exchange of confidential information regarding the above named student:Everett Public Schools and Address Phone: Fax:Information Requested (check all that apply)Official Transcript Discipline Records Academic RecordsHealth Records Educational Evaluations Immunization RecordsSpecial Education Records Social/Emotional/Disci...
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Request for Exchange of Confidential Information.pdf
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Preferred Version: Request for Exchange of Confidential Information.pdf