Chicago Public Schools Student Records Release Consent
This document is the consent form for the release and exchange of student records in the Chicago Public Schools system. It includes sections for personal information, specific records to be released, health/medical details, and authorized agencies involved. The form explains the rights of the parent and student regarding the release and inspection of records.
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How do I fill this out?
To fill out this form, follow the detailed instructions provided below for each section. Make sure to accurately provide the required information in each field. Reviewing the entire form before submission can ensure completeness and accuracy.
How to fill out the Chicago Public Schools Student Records Release Consent?
1
Fill in the student's name and date of birth.
2
Select the records to be released/exchanged.
3
Specify any health/medical information to be shared.
4
Indicate the agencies/schools involved and the purpose of the disclosure.
5
Sign and date the form, including any required student signature for mental health records.
Who needs the Chicago Public Schools Student Records Release Consent?
1
Parents seeking to transfer student records to another school.
2
Schools needing to obtain records from a previous institution.
3
Medical professionals requiring access to student health records for treatment.
4
Special education evaluators assessing student needs.
5
Legal representatives needing access to student records for case purposes.
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What are the instructions for submitting this form?
To submit the Student Records Release Consent Form, you can either email it to the relevant school's administration office, fax it to the designated number provided by the school, or submit it through the school's online submission form if available. Alternatively, you may also mail the completed form to the school's physical address. It is advisable to contact the school's administration office for specific submission instructions and to confirm receipt of the form.
What are the important dates for this form in 2024 and 2025?
The form is typically valid for one calendar year from the date of signed consent. Make sure to complete and submit the form at the beginning of the school year to avoid delays in record processing.
What is the purpose of this form?
The purpose of the Chicago Public Schools Student Records Release Consent Form is to authorize the release, exchange, and disclosure of student records between various authorized entities. This can include but is not limited to school records, health records, special education records, and other identifying information. By completing this form, parents and guardians ensure that student records are shared only with appropriate and authorized parties to facilitate educational planning, health assessments, and other necessary evaluations.
Tell me about this form and its components and fields line-by-line.
- 1. Student's Name: The full name of the student whose records are being released/exchanged.
- 2. Date of Birth: The birth date of the student.
- 3. Records to be Released: Options to select all school student records or specific records such as personally identifying information, cumulative/permanent record, disciplinary records, etc.
- 4. Health/Medical Information: Any and all records in the possession of medical providers, including mental health, HIV, and/or substance abuse records.
- 5. Agencies/Schools: Information on the agencies or schools involved in the release/exchange of records.
- 6. Purpose: The reason for disclosing the information, such as educational evaluation and program planning, health assessment and planning, etc.
- 7. Signatures: Sections for parent, student (if applicable), and witness signatures.
What happens if I fail to submit this form?
Failure to submit the Student Records Release Consent Form may result in delays or obstacles in the student's educational programming or medical treatment.
- Educational Delays: Without the release of records, necessary educational evaluations and program plans may be delayed.
- Medical Treatment: Failure to share health records could hinder medical providers from delivering appropriate care.
- Placement Issues: Special education or day school placements may be impacted if records are not exchanged in a timely manner.
- Non-Compliance: Schools may face compliance issues with state and federal regulations if records are not properly released.
- Parental Frustration: Lack of necessary records can lead to parental frustration and challenges in managing the child's education and health.
How do I know when to use this form?
- 1. Transferring Schools: When a student moves to a new school and records need to be transferred.
- 2. Medical Evaluations: When medical professionals require access to student health records for evaluations or treatments.
- 3. Special Education Planning: When planning special education services and need access to previous evaluations and IEPs.
- 4. Educational Assessments: When completing educational assessments and evaluations to plan appropriate programs.
- 5. Legal Purposes: When records are required by legal representatives for case management.
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How do I specify which records to release?
Select the relevant sections in the form that pertain to the records you wish to release.
Can I include additional records not listed in the form?
Yes, you can specify additional records in the 'Other' section of the form.
How long is the authorization valid?
The authorization is valid for one calendar year from the date of signed consent.
Can I revoke my authorization?
Yes, you can revoke your authorization at any time by submitting written notice to the local school district representative.
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