Request for Transcript and Records

REQUEST FOR TRANSCRIPTS & HEALTH RECORDS
Date

MonthDayYear
Date
Name of Former Principal
Name of School Last Attended
Street Address of School
City
State
Zip Code
School Phone Number
School Fax Number
The following student(s) have enrolled in our school indicating that your school was the last one attended.

Please send us the cumulative folder(s) showing grades, health records, testing scores and other pertinent information concerning the student. We appreciate your prompt attention in sending the requested information.
Name of Student
First Student
Grade entering
First Student
Birthdate

MonthDayYear
First Student
Name of Student
Second Student
Grade entering
Second Student
Birthdate

MonthDayYear
Second Student
Name of Student
Third Student
Grade entering
Third Student
Birthdate

MonthDayYear
Third Student
Parent's signature authorizing release of records

Clear
Should be Empty:

REQUEST FOR TRANSCRIPTS & HEALTH RECORDS