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Request for Transfer of Educational Records Form Elementary

Whitehall Public School Districts 4, 47 & 2

PO BOX 1109

Whitehall, MT 59759

Telephone: (406)287-3862

Fax: (406)287-3843

Request for Transfer of Education Records - Whitehall, Montana

Student's Previous School*

Answer Required

City*

Answer Required

Previous School's Phone Number*

Answer Required

Previous School's Fax*

Answer Required

Student Information

First Name*

Answer Required

Middle Name

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Last Name*

Answer Required

Student's Birthdate*

Answer Required

Does this student have an IEP?*

Answer Required

Yes

Does this student have a 504 Plan?*

Answer Required

Yes

PLEASE IMMEDIATELY FAX THE FOLLOWING INFORMATION TO (406)287-3843

PLEASE MAIL THE CUMULATIVE STUDENT RECORDS, INCLUDING OFFICIAL TRANSCRIPTS TO:

Whitehall Schools

Attention: School Registar

PO BOX 1109

Whitehall, MT 59759

Signature of Parent/Guardian*

Signature Required

**School Official to Complete

Answer Required

Confirmation Email

Confirmation Email *

Email Required