25/26 Request for Records Form

25/26 Request for Records Form

Union Pointe Christian Academy
Today's Date

MonthDayYear
Fax records to: 859-538-3927

Email records to:

office@unionpointeacademy.org
Student's Name

First NameMiddle NameLast Name
Student's Date of Birth

MonthDayYear
Date
School Name
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Information to be released (included but not limited to):

Directory Information
Health Records
Permanent/Cumulative Records
Pupil Personnel Services/Special Ed
IEP/MFE/All Evaluations
Official Transcript with Seal
State Testing Scores
Discipline Records
Attendance Records
Court/Custody Documents
Unpaid Fees or Obligations
Parent's Name

First NameLast Name
Parent's Signature

Clear
Kentucky Revised Code 159.70--State Education Agencies (SEA’s) are required under Section 1304(b)(3) and 1308(b) to promote interstate and intrastate coordination by providing educational continuity through the timely transfer of pertinent school records (including health information) when children move from one school to another, whether or not the move occurs during the regular school year.
Should be Empty: