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Records Request

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Today's Date:*

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Parent/Guardian First and Last Name*

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Schools:

Name and Address of Previous School:*

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Name and Address of Previous School:

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Name and Address of Previous School:

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Name and Address of Previous School:

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To comply with "The Family Education Rights and Privacy Act of October, 1974", I give permission to the above named school(s) to send the following records:*

Answer required for "To comply with \"The Family Education Rights and Privacy Act of October, 1974\", I give permission to the above named school(s) to send the following records:"

Transcript of courses, grades, attendance, and achievement test scores

Health Card and Immunization Information; other pertinent medical information

Special Education Records; Psychological Test Scores

Communication Disorders(Speech, Language, Therapy)

For the following students:

Student First and Last Name:*

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Grade:*

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Date of Birth:*

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Student First and Last Name:

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Grade:

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Date of Birth:

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Student First and Last Name:

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Grade:

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Date of Birth:

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Student First and Last Name:

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Grade:

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Date of Birth:

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Confirmation Email

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