Editing previous response:

Please fix the highlighted areas below before submitting.

Destruction of Records - Special Education Record Request

First Name*

As it appears on your State Issued Drivers License or Identification Card

Answer required for "First Name"

Last Name*

As it appears on your State Issued Drivers License or Identification Card

Answer required for "Last Name"

Birth Date*

As it appears on your State Issued Drivers License or Identification Card

Answer required for "Birth Date"

What is your relation to the student in this request?*

Answer required for "What is your relation to the student in this request?"

Student 18 years of age or older

Parent / Guardian of student

Proof of Identity*

Please provide a picture of your driver license or state issued I.D. If you are not the student and the student is over the age of 18, you must also provide proof of legal guardianship.

Answer required for "Proof of Identity"

Choose a file or drag it here.

Phone Number*

Answer required for "Phone Number"

Last year attending Centralia School District*

Answer required for "Last year attending Centralia School District"

How would you like to receive your records?*

Answer required for "How would you like to receive your records?"

Electronically (emailed as a PDF)

Hard Copy (send through USPS mail)

Please note, both email and physical address are required below to complete this request, but records will be sent by the method chosen above. Please only select one option.

Email Address*

Answer required for "Email Address"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

My signature below certifies that the information provided above is accurate and true. These records belong to me, as a student, or I am the legal guardian of the student whose records are being requested.*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"