Records Request Form

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Request for Student Record

Last School Attended:

The student mentioned below is enrolling at Mountain Phoenix Community School.

Student Information:

Student's Legal Name
Last Name
First Name
Middle Name
MM/DD/YYYY

Please send the following records:

Checkboxes

Please fax or mail requested records to: Mountain Phoenix Community School Attn: Records 4725 Miller Street Wheat Ridge, CO 80033 Phone:303-728-9100 Fax: 303-728-9801

Authorization to Release Records

Parent/Guardian Signature (Studens under the age 18):
Clear Signature
The Family Education Rights and Privacy Act of 1974, as revised, states (a) An educational agency or institution may disclose personally identifiable information from an. education record orf a student without the written consent of the parent or the student or the eligible student if (1) The disclosure is to other school officials, including teachers, within the agency or institution has determined to have legitimate educational interests. (2) The disclosure is to officails of another school or school system in which the student seeks or intends to enroll. Form Revision 8/14/2008. Questions regarding this form should be directed to 303-982-6715.

NOW ENROLLING
Preschool - Grade 8

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