Student Records Request

This is an official request for a copy of a student record. The information contained in this request should be considered private. Please complete all information in full. The information required on this page is necessary to verify and protect your school record from being accessed by unauthorized individuals.

You will receive emails from thepinnacleacademy@outlook.com to notify you of the status of your order. It is important you read those emails carefully as additional information may be required to process your request.

Once the order has been submitted and reviewed you will receive an email with a payment link. Please submit payment to finalize your order.

Name While Attending School*

First NameLast Name

Date of Birth*

Date

Parent/Guardian Names*

Mother's First NameMother's Last Name

Father's First NameFather's Last Name

Your Last Year Enrolled*

Date

Did you graduate?*

YesNo

Current Name/Requester Name*

First NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Driver's License (or other State Issued ID)*

Email*

example@example.com

Documents Will Be Delivered To:*

Please mail to the address abovePlease email to the email address aboveI will pick up documentsSend official transcript to the address listed below

Name of person to send official transcript to

Address to send official transcript

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Reason for Request of Student Record*

EmploymentCollegeIdentificationOther

Select the Information Type Requested:*

Transcript/Grades (K-12 Only) - Electronic Copy Preferred (to requester or eligible school, only) $3.00Transcript/Grades (K-12 Only) - Hard Copy Mailed $5.00Immunization Record Electronic Copy $1.00Birth Certificate Electronic Copy $1.00Other

Other $TBD:

AUTHORIZATION NOTIFICATION:
My initials below constitute an electronic signature and authorizes Pinancle Academy to release information and / or my student record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other part or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act.

Your Initials:*

Please enter your e-Signature*