JV-227 Consent to Release Educational Information Fill in court name and street address: Superior Court of California, County of This form is used to authorize the release to a child welfare agency of the educational records of a child or youth who is the subject of juvenile dependency proceedings. The records will enable the agency to ensure that the child or youth receives appropriate and effective services, as well as to carry out Fill in child's name and date of birth: case management responsibilities, assist with the transfer or enrollment of the child or youth, and inform the court of the child's or youth's educational needs. Child's Name: 1 I am a. The child's parent (my right to make educational decisions for my child has not been terminated or limited by the court). b. c. d. e. The child's legal guardian (my right to make educational decisions for the child has not been terminated or limited by the court). The child's or youth's designated educational rights holder. The child or youth (I am 18 years of age or older). The child's Indian custodian. Date of Birth: Case Number: 2 Under the Family Educational Rights and Privacy Act of 1974 (FERPA) and California state law, I authorize (allow) any school, district, county office of education, or individual or entity maintaining the child's or youth's records to release these educational records to, and discuss them with (child welfare agency): These records include, but are not limited to, attendance, academic, individualized education program (IEP), medical, social, psychological, disciplinary, developmental, speech/language, and achievement-test records. I request a copy of the records that will be released. This consent automatically ends one year from date of signature. This form is not intended to limit the right of counsel for the child or youth to access records under Welfare and Institutions Code section 317(f) or as authorized by court order. 3 4 5 Date: Type or print your name Sign your name Judicial Council of California, www.courts.ca.gov Revised January 1, 2014, Optional Form Consent to Release Educational Information (Dependency) JV-227, Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com