Skip To Main Content

Consent to Receive Confidential Information

Required

NYACK PUBLIC SCHOOLS
13A DICINSON AVE.
NYACK, NEW YORK 10960

Consent to Release Confidental Information

Must contain a date in MM/DD/YYYY format

To release all items noted below, as follows for:

Student's Namerequired
First Name
Last Name
Must contain a date in MM/DD/YYYY format
Please Mark All That Apply

PLEASE SEND THIS INFORMATION TO:

Nyack Public Schools

13A Dickinson Ave,

Nyack, NY 10960

Attn: Special Education Office
 

Attach up to 1 file with a maximum size of 10MB
No file chosen
Must contain a date in MM/DD/YYYY format

Please complete the security verification below.