Authorization to Release Gifted Records

To:   Previous school information.  

           School:_____________________________________________________

          Address:_____________________________________________________

Contact Person:________________________________________________

Phone:_______________________   FAX:_________________________

You are authorized to release confidential information on the following student:

Full Name:___________________________________________________________

Birth date:________________________   Grade:_______________

These records may be forwarded to:

            Gifted and Talented Teacher / Facilitator

            School:______________________________________________________________

        Address:_____________________________________________________________

             McKinney, TX 750_______

       FAX: __________________________________________ (preferred if possible)

Information to be released:  Any nationally-normed testing results, eligibility report,  annual assessments, etc.; all information that resulted in the placement of my child in your gifted and talented program.

Please assist in the provision of adequate services for my child by handling this request as quickly as possible.

Parent/Guardian Signature                                       Relationship                            Date