Hoosier Academies/Insight School of Indiana Student Record Request
To Be Completed by Receiving School
* Required
Name of School
*
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Requester's Full Name:
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Requester's School Email Address:
*
Your answer
Best Contact Number:
*
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School Fax Number
*
Your answer
Prefer Records Sent via:
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Choose
Email (sent to email address listed above)
Fax (sent to fax listed above)
Mail (please enter mailing address below)
Other
Mailing Address (if applicable)
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Student 1 Full Legal Name:
*
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Student 1 STN:
*
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Student 1 Birthdate:
*
MM
/
DD
/
YYYY
Student 2 Full Legal Name:
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Student 2 STN:
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Student 2 Birthdate:
MM
/
DD
/
YYYY
For Additional Students please complete another form
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