REQUEST FOR OFFICIAL SCHOOL RECORDS REQUEST FOR OFFICIAL SCHOOL RECORDS Name of Student * Name of Student First Name First Name Last Name Last Name Date of Birth * Last School Attended * School Address * School Address School Address School Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal School Address School Phone Number * School Fax Number Year Attended * Last Grade Level * Reason for Withdrawal * Please release the following Student School Records: Official High School Transcript Report Card Standardized Test Scores a. Partnership for Assessment of Readiness for College and Careers (PARCC) Assessment Report b. Northwest Evaluation Association (NWEA) Assessment Report New Mexico Standards Based Assessment (NMSBA) Report Discipline Reports Attendance Reports Individual Education Plan(IEP) Reports (if applicable) Please mail Student School Records to: Attention: Registrar Shiprock Associated Schools, Inc. PO Box 1809 Shiprock, New Mexico 87420 Fax: (505) 368-4953 If you have questions or concerns, please call the Shiprock Associated Schools, Inc's Registrar at (505) 368-2159. Signature * signature keyboard Clear Date * Submit If you are human, leave this field blank.
