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Elementary Request for Records

Request for Records

Please complete the form below, so that we may request the necessary records.

List names and grades of all students applying:

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Current School(s):

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Contact at school(s):

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Contact email(s):

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School Address

Street Address

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City

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Zip/Postal

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I authorize the release of all educational records, including progress reports, health records, and educational testing of the above named applicant to Villa Madonna Academy.

Parent First and Last Name:

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Signature*

Signature Required

School Officers: The student(s) whose name appears on this form has applied for admission to Villa Madonna Academy.

So that we may be fully informed of the applicant’s qualifications, please send us copies of the following information:

1. A copy of the applicant’s transcript

2. Progress report or transcript of courses now in progress

3. Standardized test results

4. Learning Plans and documentation for accommodations

5. Psychological or specialized testing results

6. Behavior/discipline reports and attendance records

7. Current Immunization record and health records

8. Copy of birth certificate

9. Other information that you feel might be helpful to us in evaluating this student.

We appreciate your cooperation in this process and invite you to contact our office directly with any concerns or questions you may have about this request. Please email or fax the requested information as soon as possible to:

Eileen Junker / Administrative Assistant

Villa Madonna Academy Elementary School

Fax: 859-331-8615

Email: [email protected]

Confirmation Email

Confirmation Email *

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