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Release of Records

Please complete the form below. Required fields marked with an asterisk *

REQUEST FOR RECORDS

Requesting student records for:

Name and current grade:*

Answer required for "Name and current grade:"

Current School*

Answer required for "Current School"

Fax #

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Contact*

Answer required for "Contact"

Contact Email*

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Street Address*

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City, State, Zip Code:*

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Parent:

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/Guardian signature*

Signature Required

Expected start date

Answer required for "Expected start date"

Information that will be requested:

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.

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"