Name of School Attended:

 

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School Address:

 

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City_________________________Zip_____________County______________

 

 

Please send all school records for the following student(s) who is currently enrolled in Magnolia Academy.  We need all cumulative records, testing, immunization cards, and any other pertinent information to enable us to assess student ability and grade placement.  Please include any other information that will verify subject content and proof of educational goals being met for grades given.

 

Full Name and Grade

 

________________________________________________________________

 

________________________________________________________________

 

________________________________________________________________

 

________________________________________________________________

 

________________________________________________________________

 

Please send records to:

 

I do hereby authorize Magnolia Academy to receive all school records on the students listed above.  We hold both schools blameless for any problems that may arise from the transaction of this request.

 

 
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 Parent/Guardian Signature                                        Date


______________________________________________________
Administrator Signature                                               Date

 

 

Magnolia Academy is an educational outreach of Magnolia Family Ministry in Adamsville, AL.