P.O. Box 210, Staunton, VA 24402-0210
(888) 306-8926 • (540) 885-0356 • Fax (540) 886-2275 • admissions@stuart-hall.org • www.stuart-hall.org
REQUEST FOR RELEASE OF RECORDS
Name of Student __________________________________________________ Grade_______________________
Name of School __________________________________________________________________________________
Address _________________________________________________________________________________________
Principal or Headmaster’s Name _____________________________________________________________________
Guidance Counselor’s Name ________________________________________________________________________
TO PARENTS: Please review and complete the authorization below and then give this form to your child’s
guidance counselor so that it can be processed.
In accordance with federal regulations regarding the privacy rights of parents and students under the Family Educational
Rights and Privacy Act of 1974, the undersigned hereby consents to the release of all educational records pertaining to the
above named applicant to Stuart Hall, including recommendations and other information that may be requested.
______________________________________
Signature of Parent/Legal Guardian
_______________ ______________________________________
Date Signature of Student
TO GUIDANCE COUNSELOR:
The student named above has applied for admission to Stuart Hall.
Please send the following:
1. A transcript of the student’s secondary record to date. Please include current grades.
2. A copy of the student’s complete standardized test profile.
3. Any psychological or educational testing or evaluations that may have been conducted by
professionals in your school system.
4. Attendance Records
5. Discipline Records
If this student is admitted to Stuart Hall, we will request a final transcript of the student’s record at
the conclusion of the academic year. Please keep this authorization form for your files so that another
form will not be necessary. Thank you for your cooperation and assistance.
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