School Records Request Form printable pdf download

School Records Request Form

S A I N T P E T E R T H E A P O S T L E S C H O O L

R E C O R D S R E Q U E S T F O R M

Student’s Last name, First Name, Middle Name

___/___/_____ Date of Birth (mm/dd/yyyy)

______Current Grade

RECORDS TO BE RELEASED BY:

Name of School

Mailing Address of School

City, State, Zip Code

Area Code

Telephone Number of School

Fax Number of School

AUTHORIZATION FOR RELEASE OF STUDENT’S RECORDS

You are hereby authorized to release all school records of the above named student to Saint

Peter the Apostle School. Please send a complete and official copy of the records indicate

below:

Permanent Record

Standardized Test Scores

Social Security Card

Immunization Form

Birth Certificate

Discipline Record

Special Education Records

Signature of Parent or Guardian

Date

FOR OFFICE USE ONLY:

Date Records Requested

Requested By:

“It is not necessary to have written consent of parents to release records to officials of

other schools or school systems in which the student seeks or intends to enroll.”

Privacy Rights of Parents and Students Act. Page 1213, subpart D 99 30 (b)

School Records Request Form