Student Record Release Form
Michigan Conference of Seventh-day Adventist Education System
This form grants Grand Rapids Adventist Academy permission to request a copy of your child's most recent report card, recent transcript, or a copy of your child's IEP.
Name of School of Last Attendance:
Street Address Line 2
State / Province
Postal / Zip Code
Date of Birth
I hereby authorize ___________________________________(name of school, see above line), to send a copy of HS transcript, elementary report card for last grade/semester completed, latest standardized test results, grades to date, ESL assessments, 504, IEP, or other documented accommodations and any information regarding behavior to: Grand Rapids Adventist Academy 1151 Oakleigh Rd NW Grand Rapids, MI 49504 or fax to 616.791.7242, or emailed to email@example.com.
Should be Empty:
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