Request Records

To make a formal request for individual student records, please use the form below. If you need additional assistance, please contact the school office at (661) 748-3278.

* Indicates required field

Institution or Agency *

Individual Requesting Records (ATTN) *

First

Last

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Number *

Fax Number *

Email *

Type of Records Requested (check all that apply) *

Vital Records (unofficial copies only) Immunization Records (unofficial copies only) Verification of Enrollment and Attendance Current Year Academic Records Secondary Transcripts Special Education Records

Student Name *

First

Last

Former Name (if any) *

Date of Birth (MM/DD/YYYY) *

School Identification Number (if known) *

Reason for Request *

Method of Delivery *

Fax - Faxed within 10 business days Mail - Postmarked within 10 business days Email - Emailed within 10 business days

Authorization

My initials below constitute an electronic signature and authorizes Nigritian Academy to release information and / or student record(s) and confirms I have completed all sections accurately and truthfully, including information verifying my identity. If email delivery was selected above, I hereby authorize the Academy to transmit the records electronically via email and verify that I have provided an accurate email address to receive those documents electronically. I understand that the recipient of the record(s) will use the indicated document(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other party or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act (FERPA). I declare under penalty of perjury that the foregoing is true and correct.

Initials *

Submit