Official Records Request Form
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Current Last Name *
First Name *
Middle Name
Maiden Name
Date of Birth *
MM
/
DD
/
YYYY
Last 4 of Social Security Number *
*By entering the last 4 of your social this is considered an electronic signature.
Daytime Phone Number *
Email Address
What type of record do you need sent? *
Did you graduate from Fort Zumwalt? *
Year of Graduation
Last Year and School in Attendance
If you did not graduate from Fort Zumwalt
How do you want your records obtained? *Email is preferred *
Required
Email / Mail or Fax *
Email / Mail or Fax
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