Records Request- LG Request

Records Request- LG Request
Please complete one form for each student.

Legal Guardian must complete a request if student is under 18.

If student is 18 or over, they must complete AND SIGN the request themselves. DUE TO FEDERAL LAW, PARENTS CAN NOT REQUEST RECORDS OF ANY KIND FOR AN 18 YEAR OLD OR ABOVE.

All fields must be completed.

KEEP IN MIND, THIS IS NOT A "REQUEST TO WITHDRAW" YOUR STUDENT FROM OUR SCHOOLS.
Student Name*

Full Legal First NameFull Legal Last Name
Student Date of Birth*

MonthDayYear
Student DOB
School*

Arizona Virtual Academy (AZVA)Insight Academy Of Arizona (ISAZ)
Grade Level*
Send Records To: (Select all that apply)*

School/ InstitutionLegal Guardian EmailOther
School/ Institution Name: School Name
Department / Attention to: School Information
School/ Institution Phone: School Information
School/ Institution Fax: School Information
School/ Institution Address:School Full Street Address City State Zip
Home Address: Home Full Street Address City State Zip
If Other, please list information here. You will be contacted if there are any questions regarding this request.
Please select all records that you would like sent: (Only the selected records will be sent, select all that apply). KEEP IN MIND, THIS IS NOT A "REQUEST TO WITHDRAW" YOUR STUDENT FROM OUR SCHOOLS. We appreciate your patience*

Withdrawal FormBasic Cumulative RecordsUnofficial Transcript - (High School only)Official Transcript – (High School only)Report Card (K-8th Grade only)Enrollment Verification/ Proof of Enrollment504 Accommodation PlanSpecial Education (IEP)Other
Choose the option that applies to you:*

I certify that I am the legal guardian for the above student.I certify that I am 18 years or older and my own legal guardian.
By signing here, I permit Arizona Virtual Academy or Insight Academy of Arizona to send the selected records to the school listed for the named student.
Legal Guardian Name:*

Full Legal Guardian First NameFull Legal Guardian Last Name
Legal Guardian Phone Number:*
Legal Guardian Email:*
Legal Guardian Signature*

Clear
Should be Empty: