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Today’s Date:________

Please allow 48 hrs. for processing.

Student Services Center

Student Records

1025 North Country Club Drive

Mesa, Arizona 85201-3307

Fax: 480.472.0745

Request for Records

I am requesting:

An official transcript (9-12) An unofficial transcript (9-12) Immunization Records

Permanent Record Card (K-8) Other _______________________

Name _______________________________________________________ DOB ________________

Last (Maiden) First Middle

Mailing Address _________________________________City __________________State ______Zip Code _________

Telephone Number (_____)_____________________ Fax Number (____)___________________________

Please include a clear copy of a Picture Identification (ID) Card

Last Mesa Public School Attended _____________________Last Year Attended: _________ Last Grade Attended: ______

I hereby request a review and/or copy of student information on file

Signature _____________________________________ Print Name ___________________________

*Parent *Legal Guardian Student over 18

This information will be used for the following purpose:


A. Definitions

5. "Eligible student" means a student who has reached the age of eighteen (18) years or is attending an institution of postsecondary education. When a student becomes eighteen (18) years of age or is attending an institution of postsecondary education, the rights accorded to, and consent required of, parents transfer from the parent to the student, except that the parent of any student claimed by the parent as a dependent for purposes of the Internal Revenue Code may have access to educational records without the eligible student's consent.

C. Right of Parent/Eligible Student to Inspect and Review Educational Records

Upon confirmation of identity, the parent/eligible student may inspect and review educational records. The Superintendent shall develop guidelines for the inspection and review of educational records, including provisions relative to copying educational records. The guidelines shall include information regarding the types and locations of educational records maintained by the district and the title and location of the responsible official.

Federal Register 99-31: Prior written consent not required

for education record disclosure to another educational agency

For Official Use Only
Records Clerk:________________ Date Completed:________________ Date picked up:_________________

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