Hoosier Academies/Insight School of Indiana Student Record Request
To Be Completed by Receiving School
Name of School *
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Requester's Full Name: *
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Requester's School Email Address: *
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Best Contact Number: *
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School Fax Number *
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Prefer Records Sent via: *
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: *
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DD
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Student 2 Full Legal Name:
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Student 2 STN:
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Student 2 Birthdate:
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DD
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YYYY
For Additional Students please complete another form
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