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

Date of Birth*

Answer required for "Date of Birth"

Records Requested:*

Answer required for "Records Requested:"

Transcript

Diploma

Audiogram

Other:

Send Student Records to:

Name of Location*

Answer required for "Name of Location"

Fax

Answer required for "Fax"

Phone

Number Required

E-mail

Answer required for "E-mail"

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

Answer required for "I give my permission for my records to be sent:"

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 for "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."

I affirm

Please upload a copy of your photo ID here:

Answer required for "Please upload a copy of your photo ID here:"

Choose a file or drag it here.

Signature*

Answer required for "Signature"

Date:*

Answer required for "Date:"

E-mail*

Answer required for "E-mail"

Confirmation Email

Answer required for "Confirmation Email"