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Student Records Request

Requested Records

Answer Required

Shot Records

Special Education Records

Elementary Records

Jr/Sr High Records

Other:

Student Information

Student ID

Answer Required

Social Security Number/State ID

Answer Required

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Birth Date*

Answer Required

Grade*

Answer Required

Year*

Answer Required

Graduate*

Answer Required

Graduate

Non-Graduate

Requestor Information

Requestor Name*

Answer Required

Requestor Phone Number*

Number Required

Requestor Address*

Answer Required

Where would you like the records to be sent? Please provide all information necessary to expedite your request.

Answer Required

Acceptance and Digital Signature

By typing your full name, the last 4 of your social security number, and checking the acceptance box you:

Accept the rules of this form
Agree that all information contained is accurate
Confirm that you are the individual referenced or the guardian of the individual referenced through out the form and the acceptance section and agree to use this as your Electronic signature

I accept the above statement and confirm my responses are valid.*

Answer Required

I agree

Date*

Answer Required

Full Name*

Answer Required

Last 4 of Social*

Answer Required

Upload a form of Identification

Answer Required

Choose a file or drag it here.

This can include a copy of your drivers license, birth certificate, or other standard ID document. This is not necessary, but will speed up the process of receiving your transcript.

Confirmation Email

Confirmation Email *

Email Required