SHENENDEHOWA                   
CENTRAL SCHOOLS                                                                                Records Transfer Form

I give permission for the exchange of information concerning my child,

Name:

Grade:

  

who has been registered for school at Shenendehowa Central Schools

Name of School:

    

Address:

    

City, State, Zip

    

Phone Number:

    

Fax Number:

   

Signature of Parent or Guardian

  

Date

(For Office Use Only)

Items Requested:

    • Student Transcripts
    • Current Report Card(s)
    • Standardized Test Scores (e.g., CATs, MAT’s DRPs, Iowa)
    • Regents Competency Test (RCT) Results: New York State students only
    • NYS __________ grade test results
    • NYS Regents Scores
    • NYS Proficiency Scores
    • PSAT, ACT, ACH, AP results
    • Cumulative Health Records
    • Psychological Folders
    • Disciplinary Records
    • Special Education Records, including most recent IEPs
    • Withdrawal of Grades
    • Science Labs
    • Other: All Records

Please Send Records to: School Name:

Street Address:______________________________________________________

Fax# Phone #