John Muir Charter Schools Student Records Request

John Muir Charter Schools Student Records Request
Disclaimer: This form is to be completed by the student only. 3rd party representatives can fax student record requests along with a signed student release to (530) 272-4009.
What type of record are you requesting?*

TranscriptDiploma Copy
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Apartment or Unit #

CityState

Zip Code
Phone Number*
Email*
example@example.com
Name of last JMCS site attended*
Last year attended
Did you graduate?*

YesNo
Student record to be sent by:*

EmailMailFax
Email
example@example.com
Fax Number
Name

First NameLast Name
Address

Street Address

Apartment or Unit #

CityState

Zip Code
Additional Information/Comment
By clicking on "SUBMIT" you are signing this request electronically and agree that your electronic signature is the legal equivalent of your manual signature. By selecting "SUBMIT", you are giving your consent for the release of your student records.
Should be Empty: