Official Records Request

Official Records Request
Records requested from DIA may take 24-48 hours to fulfill. If records are being picked up; parent/guardian must present valid identification.
Student Name*

First NameLast Name
Student Date of Birth*

MonthDayYear
Date
Current Grade*
Last 4 of Student Social Security Number
School Last Attended:
Student was:

PromotedPlacedRetainedNot Applicable
Current Mailing Address of Parent

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number of Parent
Parent Signature*

Clear
Should be Empty: