Student Records Request

Current Student Records Request Step 1, Please Enter All Information

This is an official request for an aspect of the student record. The information contained in this request should be considered private. Please complete all information in full and then finalize the order process through payment of the 'order fee'.

The fee payment will be paid through Amazon Payments.  The charge will show on your credit card statement as 'ASISchoolRecords' This is a secure and trusted provider of payment services.

 

 

Student's Current Name:

Information Related To Student's Birth:

Your Current Brunswick School of Attendance:

Current Residence Address: (this may be different than the mailing address)

Current Mailing Address: (if different from residence address)

Telephone Number: (###-###-####)

Driver's License: (or other State Issued ID)

Email:



Documents Will Be Delivered To: please enter the delivery addresses
Name Attention Addr 1 Addr 2 City State Zip Country # of Copies

Common Application Number: (the identifier provided by 'www.commonapp.org')

NCAA Application Number: (the identifier provided by 'www.ncaa.org')

Reason(s) for Request of Student Record:


Select The Information Type(s) Requested:


Total Fee:
$0
AUTHORIZATION NOTIFICATION:
My initials below constitute an electronic signature and authorizes the Records Department of Brunswick County Schools to release information and / or my student record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other part or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act.
 
I have enclosed the correct fees and understand that they are nonrefundable. I understand that an incomplete form will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.
Please enter your e-Signature
This field is required.


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