2025-2026 Records Request Form
Consent to release information
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Name of Student *
Student Date of Birth *
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/
DD
/
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Previous school attended *
Phone number of school *
Mailing address of school *
Email address of school *
In accordance with the federal regulations regarding the privacy rights of parents and students Under the Family Educational Rights and Privacy Act of 1974, the undersigned hereby consents to the release to Beacon Academy of all the educational records (including statement of disciplinary action or disciplinary records) and other information as may be requested about the above-named individual.
Type parent name (this will be considered your electronic signature) *
To the Principal or Secretary or Registrar:                                        
This student is applying for admission to Beacon Academy. We would appreciate your prompt sending of the following documents:
*Transcript and latest grades
*Standardized test results
*Any special testing results or placement in special programs
*Certificate of immunization and health records
*All disciplinary records or official statement of disciplinary action
Please Send All Information To:
                                 Beacon Academy
                                ATTN: Tiffany Britt
                                     PO Box 1235
                           Collegedale, TN 37315
                                     or email to
                    treasurer@beaconacademy.us
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