North Adams Public Schools - Enrolling Transfer Release Form (One Per Student)

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Parent/Guardian: Please fill out the following information so that the North Adams Public Schools can send your child's previous school a request to release their records to us. Please use YOUR email address.

Sending School District: Please fax to the school indicated, and follow up with the full set of records by mail.

To expedite scheduling for this student on our end, please also fax the transcript/report card to Central Office of the North Adams Public Schools at 413-776-1685, attention "Student Registration".

Information/Records to be released includes, but is not limited to, the following:

1. Transcript of grades and credits 5. Health records

2. Current testing; name, score, grades, date given 6. Discipline records (Massachusetts State Law)

3. Massachusetts Basic Skills testing and SASID # 7. ELL screening and assessments if applicable

4. Special Education records (including CURRENT IEP 8. Other pertinent information
and/or 504 if applicable)

Email *

Your child's FULL name (First Middle Last) *

Your child's date of birth *

YYYY

Home Address (street, city, state, zip) *

Best number to reach you during the day? *

Grade your child will be ENTERING *

Name and FULL address of the last school your child attended *

School your child is being enrolled into (based on address for grades PreK to 6 - if you are unsure, please contact Central Office at 413-776-1458 before submitting this form) *

Brayton Elementary, 20 Brayton Hill Terrace, North Adams, MA 01247 (Fax: 413-276-4432)

Colegrove Park Elementary, 24 Church St, North Adams, MA 01247 (Fax: 413-672-3247)

Greylock Elementary, 100 Phelps Ave, North Adams, MA 01247 (Fax: 413-662-3033)

Drury High School, 1130 South Church St, North Adams, MA 01247 (Fax: 413-662-3239)

(Please enter YOUR name below, not your student's) By typing my name below, I authorize and give permission for my child's records (to include all that is applicable from the top of this form) to be released to the North Adams Public Schools. This release is good for 1 year from today's date and can only be used for the intended purposes. (Chapter 71, Section 37L of the Massachusetts General Laws: A student transferring into a local system must provide the new school system with a complete school record of the entering student. Said record shall include, but not be limited to, any incidents involving suspension or violation of criminal acts or any incident reports in which such student was charged with any suspended act.) *

Your relationship to this child

Today's Date *

YYYY

Send me a copy of my responses.

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