Records Request Sample

A California Private School Since 1992 ................. .......CDS # 1 9 64725 7080740 .......... ...................P.O. Box 13038 • Long Beach, CA 90803

When transferring your child to your own family private school (i.e. you are filing your own R-4, private school affidavit) you will need to send an official records request to your child's previous school. Here is sample wording - remember to add your own information:

Request for Pupil (Cumulative) Record

Pupil Name Birthdate Grade

Susie Student 06.22.2000 3

BayShore School has enrolled the pupil listed above. Please send the complete pupil information to the address listed below by sending the Mandatory Permanent Record and all other pertinent records including health and special education information (Reference CA. Education Code 49068; and CA. Administrative Code Title 5, Sections 430, 432, 438). The parents have been notified in accordance with state and Federal Law.
Please send records to:

My New School
1234 XYZ Street
Any City, CA 90046

______now
_____ at the end of the school year

___________________________________________________________________________________
Your Name, Principal/Director/Whatever Your Title Date
Phone: 562/555.1212