SMITH COUNTY SCHOOLS

Records Request

 

FROM:           Carthage Elementary School

                        149 Skyline Drive

                        Carthage, TN 37030

                        (615) 735-0433

 

 

Name of School last attended:                      __________________________________

 

                                                                        __________________________________

 

                                                                        __________________________________  

 

Phone Number _________________________________

 

We are in the process of registering the following student:

 

Student Name            ____________________________________________

 

Birthdate:                   ­­­­____________________________________________

 

Soc. Sec. Number       _________________________ Grade _____________

 

Please complete the checklist below and return this sheet with the records to the above address:

                                                                        Sincerely,

 

                                                                        _________________________________

                                                                        Name/Title of person sending this request

 

Enclosed                None                       Not

                                Available               Applicable

 

________             _______                                _______                                Transcripts/Current Year Grades

________             _______                                _______                                Attendance Records

________             _______                                _______                                Health Records

________             _______                                _______                                Tests/Assessments

________             _______                                _______                                Discipline Records

________             _______                                _______                                Special Education Records

________             _______                                _______                                Psychological Reports

________             _______                                _______                                ESL Records

 

Is this student currently:

                Under any type of legal probation                     _______NO         _______YES

                Suspended/expelled from this school                              _______NO         _______YES

                In any type of alternative school placement    _______NO         _______YES (Explain)

 

 

_________________________________________                                                                _________________

Signature of Person Completing this report                                                 Date

 

NOTE:  According to the Final Regulations—Family Education Rights and Privacy Act (Buckley Amendment) dated July 17, 1976, it is no longer necessary to obtain written consent to release records between schools.  It states that school officials, including teachers within the educational institution and officials of other schools in school systems in which the student may intend to enroll, may receive a student’s record without written consent for such release.