Student Records Information - Request And Authorization
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2Student Records & Information – Request and Authorization
Phone 780-441-6000 Fax 780-423-3031
Edmonton Catholic Schools, CES Building, 9807-106 Street, Edmonton AB T5K 1C2
Student information
(Please print):
Student name
AKA name
Date of birth
Alberta Education ID
(YYYY/MM/DD)
(If known)
Current mailing address
Street address
City
Province
Postal code
Phone number
Alternate phone
Fax
Schools attended
: Please list the names of schools and dates attended while a student with Edmonton Catholic Schools.
Grade
School name
Year
Grade
School name
Year
Pre K
7
K
8
1
9
2
3
10
4
11
5
12
6
Information requested
(Please read instructions on the back of this page)
Student Records
Letters of Proof / Confirmation
Report cards
Confirmation of Enrolment/Attendance
Educational/Psychological Assessments
Proof of Language of Instruction
Grade 9 Transcript
Other
(Please specify)
Complete file
If you wish to provide more information, please attach additional pages.
Other
(Please specify)
When your records are ready do you want us to:
call you for pick up
mail it out
Date
Name of Requestor (please print)
Relationship to student
Signature
OPTIONAL - Release Information
If the requested records are to be released to another individual,
(If required):
agent, organization, or institution, please complete the following:
Please provide the requested records to
Name
Organization
Mailing address
Street address
City
Province
Postal code
Phone number
Alternate phone
Fax
I,
____________ allow Edmonton Catholic Schools to release the requested records to the above requestor.
Date
Signature of student/parent/guardian
Collection and use of personal information
This personal information is being collected in accordance with the School Act and the Student Record Regulation and is protected by the privacy provisions of the Freedom of Information and Protection
of Privacy Act (FOIP). This information will be used to process and issue student records. If you have any questions about the collection and use of your information, contact Student Records, Edmonton
Catholic Schools at 780-441-6000.
DM 1001/C
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