Student Records Request Form

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STUDENT RECORDS REQUEST FORM
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FOR OFFICE USE ONLY
Date Request Received _______________________________
Request Received by _________________________________ Title_________________________________________________
Date response due ___________________________________ Date response made ___________________________________
Time extended to _____________________________________ Notification of extension________________________________
Copies made____________________ How many _______________________ Cost__________________________
Denied _________________________________________________________________________________________________
Signature of employee responding ___________________________________________________________________________
*Release of records requires a valid ID and payment of the required fee

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