Release of Records

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To Whom It May Concern:

Please withdraw the student on the SOES or EMIS database. Based on this documentation and communication with the parent/guardian, the parent/guardian and Principal indicate that the following student is currently enrolled and attending a TPS school, and should be withdrawn from your school PRIOR TO THE DATE the student began attending TPS:

Student's Date of Birth
 /  / 
  MM / DD / YYYY


Date of 1st Day of Attendance at TPS
 /  / 
  MM / DD / YYYY

Contact Information

Full Name

Phone Number

Email Address

By signing this document, I, the parent/guardian, request that you officially withdraw my child from your school.

Parent Signature

Date Signed
 /  / 
  MM       DD       YYYY

*Principals: (1) Please FAX a copy of this document to the school that the student is currently attending ASAP to insure that State Funding Flows back to TPS. (2) FAX the signed form to (419) 671-8462 OR MAIL to the Student Data Office in room 212 at the Administration Building.

Please Fax Requested Student Records To:

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