AWS - Release of Records

Release of Records
To: Aurora Waldorf School
525 West Falls Road
West Falls, NY 14170
Phone: (716) 655-2029
Email: admissions@auroraws.org

Please send the following information:
Scholastic Records, including IEP, AIS, or reports of any tutoring or extra support provided
Speech/Hearing Records
Health Records
Social/Pyschological Evaluations/Records
Date*

MonthDayYear
Date
Attention
School or Agency Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Fax Number*
Please release records for*

Student's Name
Date of Birth*

MonthDayYear
Date
Parent's Name*

First NameLast Name
Parent / Guardian Signature*
Submitter's Email*
example@example.com
Should be Empty: