Permanent Records Request
Date of Request
*
-
Month
-
Day
Year
Date
Student Full Name
*
First Name
Last Name
Student Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Birth Date
*
-
Month
-
Day
Year
Date
Dates of VFBA Attendance
*
One charge is applied per request for multiple records. Please select all records you feel you need.
Types of Records Requested
*
Report Cards
IEP Records
Health Records (Immunization Records, Physicals, etc.)
Annual Attendance Records
Class/Course Grades and Credits
Behavioral Evaluations
Psychological Evaluations
IOWA/Achievement Test Results
College Entrance Test Results
Discipline Records
Other
Other (Please give a description of an item you are looking to obtain not listed above)
*
Please allow two weeks for confirmation that your request is complete.
Payment
*
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Records Request
One charge is applied per request for multiple records. Please select all records you feel you need.
$
25.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Signature
*
Submit
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