TRANSFER STUDENT RECORD REQUEST FORM

TRANSFER STUDENT RECORD REQUEST FORM
Please provide the information requested below. By doing so, you are authorizing the release and transfer of your student's school records, including all academic, health, disciplinary, anecdotal, and confidential reports to Holy Family School.
Student's Name*

First NameLast Name
Authorizing Parent/Guardian's Name*

First NameLast Name
Name of school providing records:*
Address of School Providing Records:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of School Providing Records:*

Area CodePhone Number
Fax Number of School Providing Records:*

Area CodePhone Number
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: