Parent/Student Record Request

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Please complete this form to request any student records, such as transcripts, immunization certificates, or other documents. You will receive an acknowledgment email upon submission. Please allow 24-72 hours for processing. For questions, contact Ms. Coleman at 901-791-9792.

Email *

Contact Phone Number: *

Name: *

Student Name: *

Student Date of Birth: *

YYYY

Student Grade Level or Last Grade Attended: *

Relationship to student? *

Purpose of Request:

Please specify the records you are requesting. (check all that apply) *

Transcript

Report Card

Immunization Certificate

Verification Letter

Other ( see the next question)

Required

If you are requesting anything other than the records listed in the previous question, please explain

If you are requesting a college transcript, please list below the name and address of the college(s) the transcript will be mailed to

Please select how you would like to receive the record(s). *

Pick- Up

Required

Send me a copy of my responses.

Submit

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