Student Record Request Form - New Jersey Department Of Education printable pdf download

NEW JERSEY DEPARTMENT OF EDUCATION

NEW JERSEY DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT

STUDENT RECORD REQUEST FORM

Note: The Family Educational Rights and Privacy Act: 20 USC 1232 (FERPA) requires written permission

from students to have their school records and transcripts distributed.

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The New Jersey Administrative Code 12:41 et seq. which regulates NJ Private Vocational Schools, does

not require that the NJ Department of Education or NJ Department of Labor and Workforce Development

(LWD) maintain student records. Upon receipt of this signed and notarized document, a search of

available records will be conducted on your behalf. Records provided by LWD will be unofficial.

Directions:

A request for a copy of a student transcript and/or records can only be made by the

former student. Please provide the requested information. Sign this document where requested and

have your signature notarized. Return this form to the name and address listed below.

Name: ________________________________________

SS #: _______________________________

Name of School Attended: ______________________________________________________________

Location of School Attended:_____________________________________________________________

Dates of Attendance: __________________________________________________________________

Program of Study: _____________________________________________________________________

Current Address: ______________________________________________________________________

Current Phone Number & Email Address:____________________________________________________

Name at Time of Enrollment (if different from above) _________________________________________

Please forward my records to:____________________________________________________________

____________________________________________________________________________________

I ________________________________________, hereby certify that the information above is correct

Print Your Name

to the best of my knowledge, and I certify that I am the former student requesting my own records.

___________________________________

__________________________________

Student’s Signature

Notary Signature

___________________________________

__________________________________

Date of Signature

Return to:

New Jersey Department of Labor and Workforce Development

Division of One-Stop Coordination and Support

School Approval Unit

P.O. Box 055

Trenton, NJ 08625-0055

Email: schoolapprovalunit@dol.state.nj.us

Student Record Request Form - New Jersey Department Of Education