Aug 19, 2010 - 8/19/10 9:16 AM. 2. District School Board of Pasco County. CONFIDENTIAL AND PRIVILEGED STUDENT INFORMATION FOR PROFESSIONAL USE ONLY. Motivation Assessment Scale (MAS). Demographics. Student: ID#:. Date: School: Grade: DOB: Exceptional
We may have all come on different ships, but we're in the same boat now. M.L.King
Idea Transcript
WATAUGA W A HIGH SCHOOL S STUDE ENT RECO ORD REL LEASE FO ORM
Theere will be a $12.00 $ processing charge for each traanscript and//or immunizaation record..
All inforrmation mu ust be complleted and paayment receeived beforee request wiill be processsed. _____ Offficial Transscript _____ Unofficial Transcript T ______ Immunnization Record Wataugaa High Schoo ol policy, as determined d by Federal Law, requirres that a Sttudent Recorrd Release Form F be sign ned by a stu udent eighteeen (18) yearss of age or older, or by the t student’ss parent(s)) or guardian(s) if the sttudent is und der eighteen n (18) years of o age.
NAME when w in atteendance:____________________________________________________________ Firrst Middle Laast Birth Datte:________ _________________ Sociial Security __________ _ _________________________ A ___ ____________________________________________________________________ Present Address: __________________ ___________________________________Phone:___________________________ Graduatee: _____ Yess: _____Yeaar Graduatedd____________ No: Datees Attended _________ _ _____ Mail M records to:________ t ______________________________________ ______________________________________________ ______________________________________________ _________________________________________________ _____ Faax to: _____ ____ Willl pick up AUTHOR RIZATION STATEMENT AND SIIGNATURE E I authorizze Watauga High Schoool to release the t informattion specifiedd above to thhe institutionn or individuaal named abo ove. This auuthorization or o release off records connstitutes my notification n of the releasse of the records required under the provisions p o Public Law of w 93-390. Date: __ _________ _____ ________________________________________________ Signatuure of Studennt or Parent//Guardian FOR OFF FICE USE ON NLY Receipted by: _________ _________________________________ Datee: ____________ Paid: $_______ Check #________ Processed by: _________ ____________________________________ Mail/Pick M Up Date:________ D ____