Release of Student Records

Date:
Dear Registrar of:

Previous School Name: ______________________________________

Address: _______________________________________________________________
City: ___________________

State: ____________

Zip Code: __________________

We are in the process of enrolling,

Name: ____________________________________

Social Security #: __________________________

Date of Birth: _____________________

Grade: ______________

Who formerly attended your school.

We would appreciate receiving all the information concerning this student, such as:
1.
2.
3.
4.
5.
6.
7.
8.

Health Records
Academic/Attendance Records
Test Records
Psychological tests
Special Education Records (If applicable)
Birth Certificate
Gifted and Talented Records (If applicable)
Behavioral Records (If applicable)

Please mail the above records to:

Satellite School Network
P.O. Box 28982
Costa Mesa, CA 92799