Records Request

Note: Fields marked with an * are required.

Student’s Current Full Legal Name *

Student’s Name During School Attendance *

Date of Birth (MM/DD/YYYY) *

School Attended/Graduated in Washington County *

Graduation Year

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Requester Information (Required)

Requester’s Full Name (First, Middle, Last) *

Relationship to Student: *

Requester’s Mailing Address *

Phone Number *

Email Address *

Records Being Requested *

Purpose of the Request (Required by FERPA) *

Recipient of the Records (Required by FERPA) *

Authorization & Certification (Requesters First and Last Name) *

I certify under penalty of perjury that I am authorized to request these records and the information above is true and correct.

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Student Records Request