Student Records Request

Student Records Request
Student Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
ID Number (Leave blank if you are unsure)
Current Grade*
Transferring School Information
Name of School Being Withdrawn From:*
New School Information: Please forward the student's cumulative record including academic records, health records, disciplinary records, attendance report, and scholarship record in accordance with the Family Education Rights and Privacy Act, codified at 20 U.S.C. § 1232g.
Name of School: Encompass Community School

Address: 4300 Park Ave, Nashville, TN 37209

Point of Contact: Madyson Cole, info@ecstn.org

Phone Number: 629-309-6112

Fax Number: 615-931-0167
This request for student records is being made on behalf of the undersigned parent/guardian for the purpose of school transfer.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email Address
example@example.com
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Student Information