Request For School Records Form Page 2
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1
2Candidate Name: ____________________________________
Social Security Number: ___________________________
Dates Of Attendance: __________________________ to __________________________________
Day / Evening
Degree, Diploma, Or Certificate Received: _______________________________________________________________
Previous School: ___________________________________________________________________________________
School Transferred To, If Any: _________________________________________________________________________
Truant, Lateness, Disciplinary Record: _________________________________________________________________
Home Address: ____________________________________________________________________________________
Date Of Birth: ________________________________ Place Of Birth: ________________________________________
PERSONALITY RATINGS – CHARACTER TRAITS
Please check applicable box for overall rating in each category.
POOR
FAIR
GOOD
EXCELLENT
Dependability
Cooperation
Courtesy
Appearance
EXPLANATION OF TERMS
DEPENDABILITY: Student has a sense of duty, tries harder by himself, meets obligations promptly, and is trustworthy.
COOPERATION:
Student serves the school, teachers, fellow students, and works together with others to improve
the group.
COURTESY:
Student has good manners, is considerate in dealing with others, and is obliging and disciplined.
APPEARANCE:
Student has good posture, neat habits about person, property, and work, and is neat in dress.
Is there any disciplinary record or other confidential information on file?
Yes or No ___________________. If there is,
please elaborate below or if you would prefer to have the investigator contact you personally, please indicate below.
_______________________________________________________________________________________________________
School Representative
Title
Telephone Number
Date
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