Request for Student Records

Request for Student Records

Please complete this form. We will send to the school system.
Full Name of Student

First Name Last Name
Current School
Current Grade
I am in the process of enrolling my child(ren) in Christian Heritage Academy for the following school year:
School year
I am authorizing release of all records and information to CHA and hereby request that they be sent within the next 10 days. Please include the following information:
1. A transcript of the student's record, including grades
2. A copy of all behavioral records
3. A copy of any custodial records
4. A copy of all psychological reports
5. A copy of all standardized testing data
6. A copy of immunization records
7. A copy of any confidential data
8. A copy of any tutoring/special academic arrangement records
9. A copy of any transfer records from other schools
Thank you.
Parent/Guardian's Signature

Clear
Please mail records to:

Admissions Department, Christian Heritage Academy

625 Glennwood Drive, Rocky Mount, VA 24151

Or email to: admissions@chaknights.org

**Records are used for review during the admissions process. Please do not withdraw this student from your school until further notification.
Should be Empty: