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Student Records Release

TSD

Student Records Release

For Current and Former Students

First & Last Name (as displayed on diploma or student records)*

Answer Required

Date of Birth*

Answer Required

Records Requested:*

Answer Required

Transcript

Diploma

Audiogram

Other:

Send Student Records to:

Name of Location*

Answer Required

Fax

Answer Required

Phone

Number Required

E-mail

Answer Required

I give my permission for my records to be sent:*

Answer Required

By fax

By e-mail

I affirm that I am the above-named student and request these records to be sent to the designated party within 30 days of this request. This release expires one year from the date this form was signed.*

Answer Required

I affirm

Please upload a copy of your photo ID here:

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Choose a file or drag it here.

Signature*

Answer Required

Date:*

Answer Required

E-mail*

Answer Required

Confirmation Email

Email Required