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The Consent to Search Form printed below is offered as a guide for school
officials who wish to obtain written evidence of a student’s voluntary
consent to search. Schools are free to modify this form to accommodate their
individual needs.
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Consent to Search Form (Sample)
I, __________________________________________,
(student’s name)
age ______, grade ______, at _________, on the
(time)
___________ of _________________, _______, at
(date)
(month)
(year)
___________________________________________,
(place)
voluntarily consent to a search by _________________
____________________________________________
( name of school official or school safety/resource
officer )
of _________________________________________.
(describe item or place to be searched)
I authorize the person conducting the search to seize any item that:
1) is illegal; 2) violates a school rule; 3) is evidence of a crime; or
4) is evidence of a violation of school rules. My voluntary consent
to this search is not the result of fraud, duress, fear, or intimidation.
__________________________________________
(School official’s name and title)
__________________________________________
(School official’s signature)
(Date)
__________________________________________
(Type or Print Student’s name)
__________________________________________
(Student’s Signature)
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