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Student Services - Student Records Department

2855 Colonial Boulevard
Fort Myers, FL 33966-1012

Records Specialist: Karen Lepore

Telephone: (239) 337-8182

PERMISSION FOR RELEASE, REVIEW OR COPY OF INFORMATION OF STUDENT RECORDS

You may fill out this form but you will need to print and mail the form with your fee of $1.00. This can be cash, check or money order. If paying by check or money order, please make payable to:
The School District of Lee County

Mail To:

The School District of Lee County
The Lee County Public Education Center
Attn: Student Records
2855 Colonial Boulevard
Fort Myers, FL 33966-1012

I,
(Parent/Guardian/Eligible Student)

(required)

hereby authorize: (required)

Please choose one:

Student's Name (required)
Birth Date(required)
School
SSN#(required)
Graduation Year
Withdrawal Date
Your Email Address: (required)

Which Includes:

Mailing information:

Name (required)

Street Address (required)

Address (cont.)

City (required)

State/Province (required)

Zip/Postal Code (required)
 

Purpose for Request:
Relationship to Student:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Telephone (required)