Sp ED Request Form for Records
This form is only for schools or other agencies requesting records. If you are a parent, please email our Records Department (records@pacificcoastacademy.org) with details of your request. If you are a School/Agency official, please complete this form to request a student's special education records.
Select Name of Student's Charter School
*
Please Select
Pacific Coast Academy
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Student's Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Date
Student's Grade Level
*
Please Select
TK
KN
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
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I am a...
*
Please Select
School/Agency Requesting Records
Requestor's Name
*
First Name
Last Name
Requestor's Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Position/Job Title
*
Name of your School or Place of Employment:
*
Reason for Request
*
File Review
Foster Youth
New School of Attendance
Review Hearing
Other
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Student's First Date of Enrollment at Your School
*
-
Month
-
Day
Year
Date
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Please release and mail the following records
*
Entire SpED File
Current IEP
Other
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How would you like to receive the records?
*
Emailed
Mailed
Emailed & Mailed
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Email
*
example@example.com
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Please mail documents attention to:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Position/Job Title:
*
First and Last Name
*
First Name
Last Name
Requestor's Signature:
Submit
Should be Empty: