REQUEST FOR RECORDS Date:

Last school attended: Address: City & State: The following student has enrolled at last attendance in your school/District. Please send the following: • • • • • • •

. He/she has indicated

Cumulative Record/Academic Record Discipline Record Attendance Numerical grades – if grades are not numerical, please send a grade scale/key. Health Records/Shot Records Withdrawal Grades Please indicate whether or not we need to request special education records and provide an address or phone number where we may request them.

Student Name

Grade

________________________________________ ________________________________________ ________________________________________

__________ __________ __________

I have given permission for all records of the above child(ren) to be released to the Copperas Cove Independent School District.

_________________________________________ Parent/Guardian Signature Please send records to: ______________________________________________________ ______________________________________________________ ______________________________________________________

Please note that the Buckley Amendment (dated June 17, 1976) no longer makes it necessary to have a parent’s Signature when records are being requested from one educational institution to another educational institution. Copperas Cove ISD does not discriminate against any person because of race, color, religion, sex, national origin, disability, age, or on any other basis prohibited by law. Copperas Cove ISD no discrimina a ninguna persona debido a la raza, el color, la religión, las relaciones sexuales, el origen nacional, la incapacidad, la edad, o sobre cualquier otra base prohibida por ley.

Request for Records/6-14-2017/Student Services/mr