JMCS Student Records Request

John Muir Charter Schools Student Records Request
Who is requesting this record?
Requesting party's email
example@example.com
Student Name Used to Enroll in JMCS

First NameMiddle NameLast Name
Student Name if Different from Above

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Last JMCS site attended
Last year attended
Did you graduate?
What type of record are you requesting?
Student record to be sent by:
Mail To/Attention of:
Name of the institution requesting information
Mailing Address

Street Address

Apartment or Unit #

CityState

Zip Code
Email
example@example.com
Contact Number
Format: (000) 000-0000.
Additional Information or Comments
Signed Records Request

Browse Files

Cancelof
By clicking on "SUBMIT" you are signing this request electronically and agree that your electronic signature is the legal equivalent of your manual signature. By selecting "SUBMIT", you are giving your consent for the release of your student records.
Should be Empty:

John Muir Charter Schools Student Records Request