Student Records Request Form
Name of Person Making Request
First Name *
Your answer
Last Name *
Your answer
Affiliation *
Address
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone *
Your answer
List Email Used in Your Genesis Portal *
Your answer
Release Location / Receiver *
Student Information
First Name *
Your answer
Last Name *
Your answer
Grade Level *
Student ID (if known)
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Year of Graduation if Student Graduated from Haddonfield
Your answer
Last Year & Last School of Attendance *
Your answer
Student’s Current Haddonfield School *
Your answer
Type of Record(s) Requested *
Required
Additional Information / Notes
Your answer
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