Record Request Form Requestor Information Title *This field is required. First Name *This field is required. Last Name *This field is required. Phone *This field is required. Email *This field is required. Reason for Request *New School of AttendanceOtherThis field is required. OtherThis field is required. Name of School or Place of Employment *This field is required. Learner Information Learner‘s First Name *This field is required. Learner‘s Last Name *This field is required. Learner‘s Date of Birth *This field is required. Learner‘s Grade Level *Select...TKK1st2nd3rd4th5th6th7th8thThis field is required. First Date of Enrollment at Your School *This field is required. Requested Records Please Release and Send the Following Records *Entire Cumulative RecordSpecial Education RecordsBothThis field is required. What items are needed urgently? *This field is required.0 characters / 0 words How would you like to receive these records? *Email (preferred method)FaxMailThis field is required. A hard copy will be sent in addition to email or faxed copies. Please email documents to:This field is required. Please fax documents to:This field is required. Mailing Address *This field is required. City *This field is required. State/Province *This field is required. Postal Code *This field is required. Country *This field is required. Requestor Position/Job Title *This field is required. Signature *This field is required.Clear Clear Reset Save Submit
