Name of School:

Address of School:

City, State:

Zip/Postal Code:

TO WHOM IT MAY CONCERN: Our Lady of Victory School has my permission to request your school to transfer the cumulative records for:

Name of Student:

Date of Birth: from your school where our child is/was enrolled.

Date:

Signature of Parent or Guardian:

Address:

City, State:

Zip/Postal Code:

Our Lady of Victory School agrees not to transfer the above records without permission of the parent or guardian in accordance with the provisions of the Family Educational Rights and Privacy Act of 1974.


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