School Records Request Form

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C
M
S
alifornia
anaged
chools
Records Request
I would like to request: __________________________________________
(If you are requesting a transcript, please specify official or unofficial)
Student Name: _________________________________________________
Student ID: ________________ Date of Birth: ________________________
Name, Contact Information and Relationship to Student:
_____________________________________________________________
(Check the box for proper location)
Home
School (Name of School): ____________________________________
Please send via:
Fax number: ______________________________________________
Email address: _____________________________________________
Mailing address: ____________________________________________
__________________________________________________________
Please fax this form to: (805) 581-6102 or email to:
Signature: ____________________________ Date: _________________
( Physical Signature is required)

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