Student Records Request (English)

Student Information

First Name*

Answer Required

Middle Name

Answer Required

Legal Last Name*

Answer Required

Date of Birth*

Answer Required

Mother's Full Name *

Answer Required

Father's Full Name*

Answer Required

Name of last school attended*

Answer Required

William R. Sullivan

Jack L. Kuban

Arthur M. Hamilton

Alfred F. Garcia

Last grade attended*

Answer Required

What year did the student leave Murphy School District *

Answer Required

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

Answer Required

Yes

If yes, what school year was the student promoted

Answer Required

Records Being Requested:

Please mark all that apply:*

Answer Required

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

Indicate how you want to receive the records:*

Answer Required

Pickup in Person

US Mail

Permission to release records to (Identification Required):

Answer Required

Requester Information

Please check one*

Answer Required

Self/Student (18 years or older)

Parent

Legal Guardian

Full Name*

Answer Required

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Email Address*

Answer Required

Phone Number*

Number Required

Copy of your photo ID*

Answer Required

Choose a file or drag it here.

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

Student Records Request (English)