Student Records Request (English)

Student Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Legal Last Name*

Answer required for "Legal Last Name"

Date of Birth*

Answer required for "Date of Birth"

Mother's Full Name *

Answer required for "Mother's Full Name "

Father's Full Name*

Answer required for "Father's Full Name"

Name of last school attended*

Answer required for "Name of last school attended"

William R. Sullivan

Jack L. Kuban

Arthur M. Hamilton

Alfred F. Garcia

Last grade attended*

Answer required for "Last grade attended"

What year did the student leave Murphy School District *

Answer required for "What year did the student leave Murphy School District "

Was the student promoted from 8th grade while attending this district*

Answer required for "Was the student promoted from 8th grade while attending this district"

Yes

If yes, what school year was the student promoted

Answer required for "If yes, what school year was the student promoted"

Records Being Requested:

Please mark all that apply:*

Answer required for "Please mark all that apply:"

Grades

Immunizations

Test Scores

Birth Certificate (we are not required to keep birth certificate but if it's in the student file, we will provide a copy)

Other:

Reason for Request:*

Answer required for "Reason for Request:"

Indicate how you want to receive the records:*

Answer required for "Indicate how you want to receive the records:"

Pickup in Person

US Mail

Permission to release records to (Identification Required):

Answer required for "Permission to release records to (Identification Required):"

Requester Information

Please check one*

Answer required for "Please check one"

Self/Student (18 years or older)

Parent

Legal Guardian

Full Name*

Answer required for "Full Name"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Email Address*

Answer required for "Email Address"

Phone Number*

Number Required

Copy of your photo ID*

Answer required for "Copy of your photo ID"

Choose a file or drag it here.

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

Student Records Request (English)