5500-E.3
NOTIFICATION OF RELEASE OF STUDENT RECORDS
PURSUANT TO COURT ORDER OR SUBPOENA
TO: _________________________________________________________
Parent - Student
____________________________________________________________
____________________________________________________________
____________________________________________________________
Address
The purpose of this notice is to notify you that on _________________ (date),
the _________________________________________________________
(School District) released the following documents: _____________________
____________________________________________________________
from your child's (your own) student records to _________________________
____________________________________________________________
pursuant to a court order or subpoena, a copy of which is attached hereto.
Signature ___________________________________ Date _____________
November 12, 1992
11 Boice Road
P. O. Box 2033
Hyde Park, NY 12538
(845) 229-4000
For Emergency Information (845) 229-4001
District Fax: 229-4056
Directions