Author: Hoffmann, Jason
Company: BTHS

WEST HIGH SCHOOL MAROONSEAST HIGH SCHOOL LANCERS
BTHS District 201
	4063 Frank Scott Pkg, W., 	IL 622232555 west Boulevard, Belleville, IL 62221
Phone: 618-222-7500 • Fax: 618035-2484Phone: 618-222-3700 • Fax: 618-222-3799
Belleville V Township High
BELLEVILLE EAST HIGH SCHOOL
AUTHORIZATION TO RELEASE SCHOOL RECORDS
In accordance with the Family Educational Right & Privacy Act, parent consent is not necessary to release school records to educational institutions in which a student is attempting to enroll.
NAME OF STUDENT: |
DATE OF BIRTH.' | GRADE IN SCHOOL:
PREVIOUS SCHOOL INFORMATION
NAME OF SCHOOL: | |
STREET ADDRESS: | |
CITY: | STATE: | ZIP CODE:
The student named above, who formerly attended your school, enrolled in Belleville Township High School District No. 201. Please send the below  lecolds to the individual(s) below.
Current Official Transcript | Parent/Legal Guardian Information
Withdrawal Grades / Current Schedule | Complete Discipline History
IL Student Transfer Form (ISBE 3378) | Attendance Records
ACT/SAT Test Results | PSAT Test Results
Constitution Test Results (US & IL) | Immunization Records
Concurrence Form for Athletics if applicable | Special Edu. Records - IEP or 504 Plan - if applicable
Permission is granted for release of the above records to Belleville Township High School District No. 201 Belleville East High School

	Signature of Parent/Legal Guardian or Principal	Date

920 North Illinois Street, Belleville, IL 62220-4374 • Phone: 618222-8200 • Fax: 618-233-7586
BTHS201.org