records request - McHenry School District 15

1802 N. Ringwood Road
McHenry, IL 60050
Telephone (815)385-8810
Fax (815) 363-5023
RECORDS REQUEST
The student listed below has enrolled in our school recently. Please forward the following
records to Parkland School: cumulative grade and attendance records, counselor and psychologist
reports, current copy of students I.E.P., test scores and health and dental records.
Important: Please send current percent grades for Math, Language Arts, Science and Social
Studies.
Student Name ______________________________________________________________
(Nombre del Estudiante)
Parent/Guardian Name ______________________________________________________
(Padre/Guardian)
McHenry Address __________________________________________________________
(Direccion/Cuidad/Estado/Zona Postal)
McHenry Telephone Number _________________________________________________
(Telefono)
Name of Previous School _____________________________________________________
(Escuela Anterior)
Address of Previous School_____________________________________________
(Direccion Escuela Anterior)
Grade Level________________________________________________________________
(Grado Escolar)
Previous Student Address ___________________________________________________
(Estudiante direccion anterior)
Date of Registration ________________________________________________________
(Fecha)
I am the Parent/Guardian of the student named above and authorize the release of
school cumulative records, counselor and psychologist reports, students I.E.P., test scores
and health and dental records from the above named school for educational necessary
purposes. (Doy permiso de que la informacion del estudiante antes mencionado sea otorgada
al Distrito Escolar 15 de McHenry)
_________________________________________
Signature of Parent/Guardian
Firma del Padre
________________________
Date / Fecha
Thank you for your cooperation.
Sincerely,
Michael L. Adams
Principal