The purpose of this form is to give the Academy for Urban Scholars High School (AUS) staff consent to speak with someone on your behalf in support of your academia needs to ensure your success here at AUS.

  • This form is only valid for the current school year and must be updated annually
  • Student can remove support person at anytime
  • At no time will support person be permitted to make decisions on behalf of the student

By signing this release, you grant consent and permission for school staff to discuss the below with the person identified on this form. 

  • Attendance
  • Copy of Student’s Data Form
  • Grade Card (or information about pupil placement)
  • Individual Education Plan
  • Behavior
  • Discipline
  • ALL test information / results
  • Intervention
  • Evaluation
I hereby give permission for The Academy for Urban Scholars staff to speak with:
Student Signature *

Received by: _________________________    ____________________________

                                (Print Staff Name)                        (Staff Signature)

1808 E. Broad St. ♦ Columbus, Ohio 43203  ♦ Phone: 614-545-9890  ♦ Fax: 614-545-9889

Powered byFormsite