Gospel Outreach Christian School
2800 West Cullom, Chicago, Illinois, 60618-1558                               Phone:773.604.4147   FAX:  773.604-5124
                                                                                                               K-12 college preparatory
                                                                                                                urban ministry since 1981
                                                                                                                nondenominational
 
 

Date: _________________________
 

To: ___________________________

      ___________________________

      ___________________________
 
 

I, the parent or legal guardian of the child/children listed below, hereby authorize the release of academic information, including transcripts of grades, health records, plus any other pertinent information regarding this/these pupil/s who have transferred from your school to Gospel Outreach Christian School.
 

       __________________________
       (Signature, Parent/Legal Guardian)

Name of pupil/s      Grade in your school

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________
 

Please transfer all records to this address:

      Gospel Outreach Christian School
      2800 W. Cullom Ave
      Chicago, IL 60618
     Attn: Records Administrator

You shall love the Lord your God with all your heart, and with all your soul, and with all your mind.  Matthew 22:37

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