Records Request

Student Records Request

For current students, records will be emailed through our Jupiter portal.
Requestor's Name *

First Name Last Name
Requestor's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
example@example.com
1st Student's Name *

First Name Last Name
19-20 Grade *
2nd Student's Name

First Name Last Name
19-20 Grade *
3rd Student's Name

First Name Last Name
19-20 Grade *
Records Requested (check all that apply)

19-20 Report Card 18-19 Report Card Medical Records IEP 504 Service Agreement Discipline Records Attendance Record
No. of Copies Requested: *
How would you like these records sent to you?
Signature *

Clear
Should be Empty:

Student Records Request