Student Records Request/Student Authorization for Release of Information

Submit your information if you wish to request student records.
 
Once your information is received it will be reviewed and you will be contacted if payment is required (for certificates.)
 
If you are requesting any records prior to 2001 your request will not be processed until we can verify that duplicate records can be provided.  Do not mail payments until you receive notice that your record can be duplicated.
calendar

Under Federal legislation, namely the Family Educational Rights and Privacy Act of 1974, I understand that my educational records cannot be released without my written permission or a Parental Affidavit of Dependency certified by my parent or guardian.

I, therefore, request that the information listed below be released to the following: * 
 
Information to be Released: *
 
Delivery Method *
 

This information is released subject to the confidentiality provisions of appropriate state and federal laws and regulations which prohibit any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations.

In executing this authorization, I fully and completely release and hold harmless all present and past CRY-ROP employers and their officers, agents, assigns and employees, and all other persons and entities from liability for any damage, including, to the full extent allowed by law, liability under the State and Federal Constitutions, California Civil Code Sections 45 and 46 and California Labor Code Section 1054 or any similar laws of other states or political entities, which may result from furnishing information which I am permitting to be released by way of this authorization.

I have carefully read and understand all of the provisions of this authorization and have voluntarily and without coercion or duress agreed to and signed this authorization. I acknowledge and understand that this release is valid until I revoke this release by delivery of written notice to CRY-ROP.

Signature Required   (by signing my name, I certify that I am the individual named above.) *
clear
calendar
 
Please allow up to 5-7 business days for processing once your authorization form has been received.