Record Request Form

Email *

Requestor’s Name *

Requestor’s Phone Number *

Reason for Request *

New School of Attendance

Name of School or Place of Employment *

Requested Records

Please Release and Send the Following Records *

Entire Cumulative Record

Special Education Records

Both

What items are needed urgently? *

How would you like to receive these records? *

email (preferred method)

fax

mail

A hard copy will be sent in addition to email or faxed copies.

Please email documents to: *

Please fax documents to: *

Please mail documents to: *

Country

City

State

Zip code

Position/Job Title *

Requestor’s Signature *

Signature is required.

reCAPTCHA is required.