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Student Records Request

Requested Records

Answer required for "Requested Records"

Shot Records

Special Education Records

Elementary Records

Jr/Sr High Records

Other:

Student Information

Student ID

Answer required for "Student ID"

Social Security Number/State ID

Answer required for "Social Security Number/State ID"

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Birth Date*

Answer required for "Birth Date"

Grade*

Answer required for "Grade"

Year*

Answer required for "Year"

Graduate*

Answer required for "Graduate"

Graduate

Non-Graduate

Requestor Information

Requestor Name*

Answer required for "Requestor Name"

Requestor Phone Number*

Number Required

Requestor Address*

Answer required for "Requestor Address"

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

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

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

I agree

Date*

Answer required for "Date"

Full Name*

Answer required for "Full Name"

Last 4 of Social*

Answer required for "Last 4 of Social"

Upload a form of Identification

Answer required for "Upload a form of Identification"

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 *

Answer required for "Confirmation Email"