Request for Records

Request For Records

2024-2025
DATE OF REQUEST*

MonthDayYear
Date
STUDENT INFORMATION
Name*

First NameMiddle NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Of Birth*

MonthDayYear
Date
Highest Grade Completed*
PARENT/GUARDIAN INFORMATION
Parent / Guardian Name*

First NameLast Name
Relationship To Child*
Email Address*
example@example.com
Phone Number*
TRANSFER SCHOOL INFORMATION
Previous School Attended*
City / State*
I give permission for my child's confidential records, including but not limited to: report cards, state test information, birth certificate, baptismal certificate and health records, to be released for the child listed above.
Parent / Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: