Service Record Request Form
Date of Request *
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DD
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YYYY
First and Last Name: *
Your answer
Last four digits of your Social Security number: *
Your answer
Last day worked at Terrell ISD *
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DD
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YYYY
Phone number: *
Your answer
E-mail: *
Your answer
Please check the items listed below that you are requesting to be sent to you: *
Please enter the name and address where you would like to have your service record mailed: *
Your answer
By clicking "submit" on this Service Record Request Form, I warrant and represent that I am the person whose name appears in item numbers 2 and 3 above, and I authorize Terrell Independent School District ("Terrell ISD") to send my Terrell ISD original service record and any of my official transcripts in Terrell ISD's custody to the person or entity listed above. I further release and hold harmless Terrell ISD and its employees, directors, and agents from all liability for any injury or damage of any nature, including liability for any injury or damage resulting from gross negligence, that I or anyone acting by or through me may sustain as a result of my request for Terrell ISD to transmit my original service record and official transcript(s) to the person or entity listed in item number 9 above. I have read and understand this authorization, and I execute this authorization and consent willingly.
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