FORM 8
EDUCATIONAL RECORDS RELEASE
I hereby authorize the appropriate school official or designated representative of the Grove City Area
School District to obtain educational records for the following student:
/
Student Last Name
Student First Name
/
Date of Birth
RELEASE INFORMATION TO:
Email Address:
Ruthe Malumphy, Guidance Secretary
rmalumphy@gjr.k12.pa.us
OR
Mailing Address:
George Junior Republic School
Attention Guidance Secretary
233 George Junior Road
Grove City, PA 16127
Contact Jim Anderson, Principal, George Junior Republic School, at 724-458-9330 x3701 or
janderson@gjr.k12.pa.us with any questions or concerns.
Signature of Parent / Guardian / Student (if 18 years of age or older)
Date
Printed Name of Parent / Guardian / Student (if 18 years of age or older)
Please provide me a copy of the released information:
No
Yes - indicate
Email or
US mail and complete below
Email Address:
Mailing Information:
Printed Name of Parent / Guardian / Student (if 18 years of age or older)
Street Address
City
State
FOR OFFICE USE ONLY
Date Released:
Zip Code
Email
US mail
Released by:
233 George Junior Road  P.O. Box 1058  Grove City, Pennsylvania 16127  724-458-9330 Ext. 2100  Fax: 724-458-8401