Name and Address of School

Name and Address of school: ______

Please release all information below for: ______. (Student name)

* Transcript of grades * Release of Standardized Testing * Health Records and Immunization Records * Psychological Evaluation * Educational Evaluation * All Category II Files * Social History * Medical Evaluation * Speech/Hearing Evaluation * IEP or 504 Plan, Eligibility meeting minutes, and Educational and Psychological Evaluation * Discipline * Permission to speak to school by phone * Other ______

All Records should be mailed to: Cornerstone Christian Academy PO Box 2228 Abingdon, VA 24212

Thank you for your assistance.

______Signature of Parent/Legal Guardian Date

Cornerstone Christian Academy PO Box 2228 Abingdon, VA 24212 www.cornerstoneabingdon.org