Record Request Form
This form is to be completed by the parent or legal guardian to request an official copy of records for a student enrolled or previously enrolled at our school. We can send a copy of the records home with current students, or you can pick it up in person. For former families, SJCS will be in touch with the best option for obtaining a copy of the records. There is a $5 charge per copy.
Student Information:
I am requesting a record request for.
Alumni
Current student
Former student
Student Name:
*
Student First Name
Student Last Name
Date of Birth:
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Grade Level:
*
Grade Number
Completed Grade Level at SJCS:
*
Grade Number
Parent or Legal Guardian Information:
Parent/Guardian Name:
*
First Name
Last Name
Relationship to Student:
*
Father/Mother/Guardian
Email:
*
example@example.com: must match our records
Mailing Address:
*
Street Address
Street Address Line 2
City
State
Zip Code
Contact Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Record Request Details
Please specify the detail of your transcript request below.
Purpose of Transcript:
*
i.e. High School Application; Transferring Schools
Select the Items that are being requested - Each form may be used to request a maximum of three records. Please complete an additional form if you need to request more than three records.
*
Report Card - last year of enrollment
Report Card - 2nd-to-last year of enrollment
Standardized test record (add the test name and year below)
Other - Type Specific Record below:
Type record name
My Products
*
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next
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Record Request
Number of Copies of the requested records above
$5.00
$
5.00
Quantity
1
2
3
4
Item subtotal:
$0.00
$
0.00
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Authorization and Signature
By signing below, I authorize the release of my child's official school record as described above.
Signature
*
Print Name
*
First Name
Last Name
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Continue
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