Parental Permission Release or Exchange of

Confidential Information

Date:___________________________

To: Athens ISD

Regarding request of ________________ or ALL SCHOOLS AND COLLEGES

It is with my full knowledge and consent that I authorize the release and/or exchange of confidential information concerning

________________________________________________

(Student's Name and Birth Date)

with the above named agency or individual. Any and all information pertinent to the education and care of my child may be released and/or exchanged. This information is to be used for educational planning and placement purposes.

Signed:_____________________________________

(Parent or Guardian, or student if 18)

___________________________________________

(Address)

___________________________________________

(City, State, Zip)

__________________________________________

(Telephone)