23-24 Records Request Form

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Request Student Records

Date of Request *

YYYY

Type of Records Requested *

Unofficial Trascript

Official Transcript

Duplicate Diploma/$10 FEE

Enrollment Verification Letter

Copy of Medical Records

Copy of Enrollment Documents

Report Card

Attendance Report

Other:

Required

Additional Comments on Records Requested

STUDENT First Name *

STUDENT Last Name *

STUDENT Status *

REQUESTER Full Name (if other than student)

Requester Phone Number

Requester Email Address *

Is This Records Request for a Current Student Withdrawal? *

If The Answer to This Question is YES, Please be Sure to Complete a STUDENT WITHDRAWAL FORM

Yes

Method of Delivery *

Faxed

Picked Up

Mailed

Mail/Fax/Email Records to:

IF YOU ARE AN EDUCATIONAL OR HUMAN SERVICES AGENCY, PLEASE EMAIL ANY AUTHORIZATIONS TO admissions@imhotepcharter.org

Date Records Due *

YYYY

Submit

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