Letter Head HEADER center.jpg

REQUEST FOR RECORDS

The student listed below has enrolled in Bentley Schools. Please forward CA-60, immunization, transcript, and any behavior report records for this student:

 STUDENT INFORMATION

Student Name:

Birthdate:

Grade:


 PREVIOUS SCHOOL

Name:

Street Address:

City, State, Zip Code:

 PLEASE SEND RECORDS TO (Check one):

Grades K-5
BARHITTE ELEMENTARY
6080 Roberta
Burton, MI 48509

Phone: 810.591.9645

Fax: 810.591.9198

Grades 6-8
BENTLEY MIDDLE SCHOOL
1180 N. Belsay Road
Burton, MI 48509

Phone: 810.591.9043

Fax: 810.591.9166

Grades 9-12
BENTLEY HIGH SCHOOL/BOLD

1150 N. Belsay Road
Burton, MI 48509

Phone: 810.591.9514

Fax: 810.591.9158

⃣  Parent indicated that student was receiving Special Education services. Please fax copies of the current IEP, most recent Re-Evaluation and MET and psychological evaluation to the Bentley Special Services office.

⃣  Parent indicated that student was not receiving special Education services, but please check records and, if present, fax copies of the current IEP, most recent re-evaluation, and psychological evaluation to the Bentley Special Services office.

Bentley Special Services Office
1150 N. Belsay Road, Burton, MI 48509

Phone: 810.591.9543

Fax: 810.591.9457

Signature of Parent/Guardian _____________________________________________ Date _______________________

footer.jpg