By entering my name in the fields below, I attest that the information provided on this form is true and accurate to the best of my knowledge and that the information obtained through this report request must be kept secure and confidential, only to be shared with others in my agency if strictly necessary. Further, I understand that the information contained in any report(s) my agency may receive is subject to the Family Educational Rights & Privacy Act (FERPA) as it pertains to the student's educational program. My typed name in the fields below constitutes my legal signature.