Coffee County School System

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Request for School Records

Student Name *

Date of Birth *

YYYY

Grade *

Name of Previous School *

Address of Previous School *

City, State, Zip of Previous School *

Phone number of Previous School *

Fax number of Previous School *

Email of Previous School

My consent is given for my child's records and/or all other pertinent information to be released to the Coffee County School System. All information obtained will be kept strictly confidential. I give permission for the Coffee County School System to obtain verbal clarification on any information received. *

Yes

Initial for Parent Consent to Request Records *

Parent/Guardian Signature (Type full name) *

Parent/Guardian Phone Number *

Date *

YYYY

Submit

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