Cms Student Records Request Form printable pdf download

Request 1 Date

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Request 2 Date

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Student Records Request

2014-2015

Request 3 Date

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Charlotte Mecklenburg Schools Student Records Request

CMS Student Records Department

700 East Stonewall Street, Suite 706, Charlotte, NC 28202

Email: StudentRecords@cms.k12.nc.us  Phone: 980-343-5424

Send requested records to:

School/Department Name: ___________________________________________

CMS Courier #: _______

To the Attention of: __________________________________________________________________________

Requestor’s Email Address: _____________________________________________________________________

School Address:

__________________________________________________________________________

School Fax Number: __________________________________________________

School Phone Number: _________________________________________________

Requesting records from:

School Name:

_____________________________________________________

Attention:

_____________________________________________________

Fax Number:

_____________________________________________________

Charlotte Mecklenburg Schools is requesting the following Student Data/Records:

• Formal Withdrawal/Transfer Form including the most current average for each course in which the student is enrolled (numerical & letter grade

with grading scale)

• Send most recent Transcript (High Schools Only)

• Student’s Birth Certificate and all Immunization & Health Records (required to have the doctor’s/official copy of birth certificate and

immunization records)

• All Discipline Records to date including any arrest records, juvenile arrests, or referrals to juvenile detention

• All legal documentation including the most current custody/guardianship documentation

• ALL Report Cards, including the most current quarterly report card

• ALL Test Scores, including but not limited to State Testing, End of Grade and End of Course testing, etc.

• ESL (English as a Second Language) Evaluations, Testing, and documentation

• All Individual Education Plan (IEP) documentation and accommodations to date including all IEP Service Evaluations and all Psychological

Evaluations

• 504 Plan, please include all documents to date

• Advanced Placement or Academically Gifted program documentation and testing results

It is North Carolina law that Immunization Records are sent/received 30 days after enrollment.

Students are subject to suspension/exclusion if immunizations are not received and in compliance by the 30

day after enrollment.

Student’s Information

Student’s Name:

__________________________________________________________________________

Last Name

First Name

Middle Name

Student’s Date of Birth:

_________________________________

Current Grade Level: ________

Current NC ID Number:

_________________________________

Historical NC ID Number:

_________________________________

AIS BOX#:_________

(CMS Only)

I consent for the above named school to release my child’s school records and any legal documents to Charlotte-Mecklenburg Schools.

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Parent/Guardian Signature

Parental permission is no longer required when authorized school personnel require records (Family Educational Rights and Privacy Act, Final Rule on Educational

Records, Federal Register, June 17, 1976, Vol. 41, No. 118, Page 24673)

REV: 08/14/14

Cms Student Records Request Form

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