SCS REQUEST FOR RECORDS

Sweetwater City School System

Records Request Form
REQUEST FOR RECORDS
Student will attend which School?*
Enrollment Date

MonthDayYear
Date
Grade
Teacher
STUDENT NAME
SS #
D.O.B.
City of Birth
State of Birth
County of Birth
Mothers Malden Name
NAME OF PARENT/GUARDIAN
ADDRESS OF PARENT/GUARDIAN
Name of Last School Attended
Phone # of Last School Attended
FAX#
Address of Last School Attended
STUDENT WILL BE RESIDING WITH
Please send all records for the above-named student now enrolled in the Sweetwater City School System. This should include academic, attendance, health and immunization records, special education records, disciptinary records, and any other information needed for appropriate placement of sald student(s
Signature of parent/guardian

Clear
Date

MonthDayYear
Date
My child DID or DID NOT receive Special Education Services at his / her former school
School

Please send all records by fax, mail or email to the school listed below that your child will be attending:

BIS
Grades: 5-6
135 Starrett Street
Sweetwater, TN 37874
(423)337-5905
(423)337-0791 Fax

SPS
Grades: PK -2
500 Highway 322E
Sweetwater, TN 37874
(423) 351-7004
(423) 351-7089
Fax

SES
Grades: 3-4
301 Broad Street
Sweetwater, TN 37874
(423) 337-7062
(423) 337-7609
Fax

SJHS
Grades: 7-8
1013 Cannon Ave.
Sweetwater, TN 37874
(423) 337-7336
(423)337-7360
Fax

According to the final regulations of the Family Educational Rights and Privacy Act (Buckley Amendment 99.33) dated June 17, 1976, it is stated that school officials, including teachers within the educational institution and officials of other school systems to which the student may inted to enroll, may receive a student's record without a written consent for such release.

School?
Should be Empty:

Sweetwater City School System

REQUEST FOR RECORDS