Records Request- LG Request

Please complete one form for each student and school, email or address you would like records sent to.

Legal Guardian must complete a request if student is under 18.

If student is 18 or over, they must complete AND SIGN the request themselves as Legal Guardian or the request will be declined or rejected. DUE TO FEDERAL LAW, PARENTS CAN NOT REQUEST RECORDS OF ANY KIND, FOR AN 18 YEAR OLD OR ABOVE.

All fields must be completed.

Student Name*

Full Legal First NameFull Legal Last Name

Student Date of Birth*

Student DOB

School*

Arizona Virtual Academy (AZVA)Insight Academy Of Arizona (ISAZ)

Grade Level*

Send Records To: (Select all that apply)*

School/ InstitutionHomeOther

School/ Institution Name:
Department / Attention to:
School/ Institution Phone:
School/ Institution Fax:
School/ Institution Address:Full Street Address City State Zip

Home Address: Full Street Address City State Zip

If Other, please list information here. You will be contacted if there are any questions regarding this request.

Please select all records that you would like sent: (Only the selected records will be sent, select all that apply). KEEP IN MIND, THIS IS NOT A "REQUEST TO WITHDRAW" YOUR STUDENT FROM OUR SCHOOLS. We appreciate your patience*

Withdrawal FormState Standardized Test ScoresUnofficial Transcript - Faxed (High School only)Official Transcript – Mailed (High School only)Report Card (K-8th Grade only)Birth Certificate/ Custodial PaperworkImmunizationEnrollment Verification/ Proof of EnrollmentOther

SPECIAL EDUCATION RECORDS: If your student participated in our SPECIAL EDUCATION program and need records, PLEASE click "YES" below

Yes, I DO need Special Education RecordsNo, I do NOT need Special Education Records

Choose the option that applies to you:*

I certify that I am the legal guardian for the above student.I certify that I am 18 years or older and am my own legal guardian.

By signing here, I permit Arizona Virtual Academy or Insight Academy of Arizona to send the selected records to the school listed for the named student.

Legal Guardian Name:*

Full Legal Guardian First NameFull Legal Guardian Last Name

Legal Guardian Phone Number:*

Legal Guardian Email:*

Legal Guardian Signature*

Clear