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Student Records Request Form

Required

NYACK PUBLIC SCHOOL DISTRICT CENTRAL REGISTRATION

Administrative Building ∙13A Dickinson Ave∙ Nyack, New York 10960∙ (845)353-7038

STUDENT RECORDS REQUEST FORM / SOLICITUD DE REGISTROS ESTUDIANTILES
(Parent or guardian must fill out / Debe ser llenada por padre o tutor)

Nombre y dirección de la escuela a la que asistió anteriormente
Must contain a date in MM/DD/YYYY format
Student’s Name/ Nombre del Estudiante:required
First Name
Last Name
Must contain a date in MM/DD/YYYY format
school year.
Please forward all academic records within 48 hours of the receipt of this request (attendance records, quarterly grade, progress reports, etc.), NYSITELL, NYSESLAT/ELL scores, health records, discipline records and/or any pertinent information concerning the student to the school indicated below.
Thank you for your assistance in this matter.
 
Sincerely,
 
Nyack Public School District
 
I hereby authorize release of all records to Nyack Public Schools. * Por la presente autorizo liberar todos los registros a las Escuelas Públicas de Nyack.
Parent/Guardian Name / Nombre del Padre or Guardian:required
First Name
Last Name
Attach up to 1 file with a maximum size of 10MB
No file chosen
Must contain a date in MM/DD/YYYY format
For Office use
Must contain a date in MM/DD/YYYY format

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