Student Records Request

Online Higher Ed Information 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'.

We may respond to this corporate request by the medium of our choosing (email, mail, or fax).  You will be notified of the delivery mechanism by email.  Status can be checked via the 'Order Tracker'

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.

 

Higher Ed Requestor Information:

Admissions Address:

Admissions Telephone: (###-###-####)

Email:

Student's Name While Attending School:

Information Related To Student's Birth:

Student's Last Brunswick School of Attendance:

Student Current Name:

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

Student's Current Mailing Address: (if different from residence address)

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



Reason(s) for Request of Student Record:


Select The Information Type(s) Requested:


Total Fee:
$0
AUTHORIZATION NOTIFICATION:

I hereby certify and verify that my corporation has expressed written consent to release information from the former student of Brunswick County Schools for which this request is made. I understand that the recipient of the record(s) will use said 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 the expressed written consent of the former student except under authority of Public Law 93-380, Educational Rights and Privacy Act. By clicking 'Proceed to Checkout', I certify this information as complete and accurate.

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.

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