TANNEHILL

           PERMISSION FOR THE TRANSFER AND/OR RELEASE OF

CONFIDENTIAL STUDENT INFORMATION

I, __________________________, the parent or legal guardian(s) of ___________________________, a student at

          (Name)                                                                                                                   (Name)

_______________________, ___________________________ Public Schools, request that the following part of the

          (School)

above student's records

_________________________________________________________________________________________

_________________________________________________________________________________________

be made available to __________________________________________ for the purpose of

                                          (Name)

_________________________________________________________________________________________

_________________________________________________________________________________________

Date: ____________________                                                                _____________________________________

                                                                                                                          Signature of Parent

__________  Please send me a copy of the records released at the following address:

                          Name                     _________________________________________________________________

                          Address                  _________________________________________________________________

                          City, State, Zip     _________________________________________________________________

__________  Please send a copy to the above student at the following address:

                          Name                     _________________________________________________________________

                          Address                  _________________________________________________________________

                          City, State, Zip     _________________________________________________________________

Enclosed is $_______________ for reproduction and mailing.