KILLEEN INDEPENDENT SCHOOL DISTRICT



KILLEEN INDEPENDENT SCHOOL DISTRICT

Bellaire Elementary School

Records

108 West Jasper

Killeen, Texas 76542

Phone (254) 501-1412 or 1414

Fax (254) XXX-XXXX

Request For Records

DATE: __________________________

TO: __________________________

FAX: __________________________

FROM: __________________________

Total number of pages including cover sheet: ____

The Student(s) named below registered in the Killeen Independent School District for the year. To better assist us in scheduling and planning a program to benefit each student(s) educational goals, we request any and all school records for the student(s) named below, including:

____ A complete transcript through current level and transfer grades for current session

Elementary Students: Grades 1-5

Secondary Students: Grades 6-12

____ A copy of the most recent report card

____ Health records, Immunizations records, Birth Certificate and SSN card

____ Standardized Test Scores (Include TAKS for Texas schools)

____ An Interpretation of your grading system

____ Attendance and Disciplinary records

____ Entry and Withdrawal dates

____ Information concerning special programs (Special Ed, Bilingual, 504, Gifted)

Please send the records to the address above.

Last Name First Name MI Grade Date of Birth

Last Name First Name MI Grade Date of Birth

Last Name First Name MI Grade Date of Birth

I GIVE MY PERMISSION FOR ALL RECORDS OF THE CHILDREN LISTED ABOVE TO BE RELEASED TO THE REQUESTING CAMPUS.

Date Parental Release Signature KISD Representative Assigned Campus

KISD Form 285-708

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