AUTHORITY TO RELEASE LETTER
Date: ______/______/______
To: Brownsville Independent School District
C/O: Records Management Office
4310 E. Morrison Rd.
Brownsville, Texas 78521
(956) 544-3972 / Fax: (956) 574-6459
I, ______do hereby authorize ______
Name of Requestor Name of person authorized to pick up
to pick up my transcript and/or immunization records.
The person authorized to pick up my records is a: parent, wife, husband, friend,
Other:______
Remarks: ______
______
Authorized Signature: ______
Note: / A picture identification copy of the person authorizing this document MUST be attached to this form and to the Records Request form.The person authorized to pick up the records must also present their picture identification card.
FORM: RC602 Updated 7/24/12
BISD is an equal opportunity employer, and does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or provisions of services, programs or activities.