Request for Student Public Data
Student Information & Reporting
4570 Victoria St N
Shoreview, MN 55126-5800
Telephone: 651-621-6014
Fax: 651-621-6026
Date of request *
MM
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DD
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YYYY
Name *
Your answer
Name of Organization *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email Address *
Your answer
Data Type *
NOTE: A fee is required to cover the costs of compiling the data and is due prior to delivery of the data. After submitting this form, please send a check payable to ISD #621 to the address above, or make credit card payment through PayPal: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=X95DBCAFTR6VN
Information Requested (please check each item requested): *
NOTE: It is important to indicate all information that you are asking for on this form. If additional information is requested after the list has been completed, it will be treated as a new request with a new charge.
Required
Please list any other detailed information about your request, (i.e. how it should be sorted, which schools and grades are being requested, nonresidents excluded, etc.): *
Your answer
Name of person requesting information *
By entering my name, it is agreed that this data will not be redistributed to any third parties in accordance with the Family Educational Rights and Privacy Act.
Your answer
Before submitting this form
If you would like to pay for this request using a credit card, you can make a credit card payment through PayPal using this link: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=X95DBCAFTR6VN
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