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    transcriptRequestForm (E Mail)

    Uploaded by

    Mengel O. Davis
    This document is a transcript/immunization request form for the Volusia County School District. It instructs that a $1 fee per request and photo ID are required to process student record requests. The form requests information to identify the student and the person/agency requesting the records. It lists the types of records available and authorizes the school district to release the specified records to the requestor. A signature is required to process the request.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    transcriptRequestForm (E Mail)

    Uploaded by

    Mengel O. Davis
    17 views1 page
    This document is a transcript/immunization request form for the Volusia County School District. It instructs that a $1 fee per request and photo ID are required to process student record requests. The form requests information to identify the student and the person/agency requesting the records. It lists the types of records available and authorizes the school district to release the specified records to the requestor. A signature is required to process the request.

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    transcriptRequestForm(e-mail)

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    This document is a transcript/immunization request form for the Volusia County School District. It instructs that a $1 fee per request and photo ID are required to process student record requests. The form requests information to identify the student and the person/agency requesting the records. It lists the types of records available and authorizes the school district to release the specified records to the requestor. A signature is required to process the request.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    17 views1 page

    transcriptRequestForm (E Mail)

    Uploaded by

    Mengel O. Davis
    This document is a transcript/immunization request form for the Volusia County School District. It instructs that a $1 fee per request and photo ID are required to process student record requests. The form requests information to identify the student and the person/agency requesting the records. It lists the types of records available and authorizes the school district to release the specified records to the requestor. A signature is required to process the request.

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    © All Rights Reserved
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    VOLUSIA COUNTY SCHOOL DISTRICT

    TRANSCRIPT/IMMUNIZATION REQUEST FORM


    Instructions: this form is to be used by the eligible legal guardian or eligible student (18 or older)
    to request and authorize the release of student information. The eligible legal guardian or student must
    provide a legible copy of his/her photo identification.. If the student is under 18, please also submit a
    copy of the birth certificate along with your photo id. Fee for records are $1.00 per request. You may email the form back to
    nryates@volusia.k12.fl.us or mail to: Archives and Records, PO Box 2118, Deland, FL 32720.

    REQUESTS FOR STUDENT INFORMATION WILL NOT BE PROCESSED WITHOUT THE PROPER FEE AND PHOTO
    IDENTIFICATION.

    I AUTHORIZE THE SCHOOL DISTRICT OF VOLUSIA COUNTY TO RELEASE MY RECORDS TO:

    PICK-UP MAIL TO FAX E-MAIL


    NAME OF AGENCY/PERSON: _____________________________________________________________

    ADDRESS: ___________________________________________________________________________
    CITY: ___________________________________STATE:_________________________ZIP:___________
    FAX: ____________________________________E-MAIL: _____________________________________

    RECORDS OF (FULL NAME WHILE ATTENDING SCHOOL) __________________________________________________________________


    LAST FIRST MIDDLE MAIDEN
    CURRENT ADDRESS: ________________________________________________________________________________________
    STREET CITY STATE ZIP

    DATE OF BIRTH: __________________ ALPHA CODE (IF AVAILABLE): ___________DATE LAST ATTENDED: ______________

    LAST VOLUSIA COUNTY PUBLIC SCHOOL ATTENDED: ___________________________________________________________

    RECORDS REQUESTING: HS TRANSCRIPT IMMUNIZATIONS VERIFICATION OF GRADUATION ELEMENTARY


    ESE(Exceptional Student Education) ESE records will consist of IEP, Psychological and Transcripts unless otherwise noted. ESE
    records area $0.15 per page

    AUTHORIZATION STATEMENT AND SIGNATURE


    I authorize the School district of Volusia County to release the information specified above to the agency or individual above. I
    understand that as an eligible parent/legal guardian or eligible student who is 18 years of age, have the right to review all records or
    student information being forwarded to the receiving party prior to release. I have also been informed that i have a right to a hearing
    to contest any information contained in requested records prior to release. I hereby authorized the release of records or information
    requested. I understand that Volusia County Schools cannot guarantee the confidentiality of any information that is sent via fax or
    email. I further understand that transcripts that are faxed or e-mailed may not be considered official by the receiving agency.

    HOWEVER, PLEASE FAX EMAIL MY RECORDS TO THE NUMBER/E-MAIL ADDRESS LISTED ABOVE.

    SIGNATURE ____________________________________________________ DATE _____________________________

    For office use only


    Date Recv’d: __________BY:_____________________
    COPY OF PHOTO ID Cash: ___Check:_____Check #______Amt: $_________
    Online Payment Order Number:___________________
    Payment Amount:$________________
    Date Sent: ________Student Pick-up:___________

    You may email your request back to nryates@volusia.k12.fl.us or


    mail to Archives and Records PO Box 2118 Deland, FL 32720

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