Former School Name:
Former School Name: _________________________________________
Former School Address: _______________________________________
Phone: _________________________ Fax: ________________________
State of Alabama
Department of Education
Official Request for Student Records
Date of request: ____________
The Alabama Department of Education and Windham Elementary School request that you transmit the following student records as soon as possible. If the student is currently receiving special education and related services, the records must be transferred to the requesting school. (Alabama Administrative Code 290-080-090.03)
Last First MI Grade
Last First MI Grade
Last First MI Grade
Last First MI Grade
_________________________________ Mailing Address:
Parent Signature Windham Elementary
200 Heritage Drive
Daleville, Al. 36322
334-598-4466
334-598-4467 fax
Please fax the checked information and mail the rest:
_____ Birth certificate _____ SSN
_____ Immunization Certificate _____ Legal custody papers
_____ Report card or withdraw papers with grades
_____ DIBELS reports
................
................
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