ADULTPRIVATE
CAREERSCHOOL
STUDENTRECORDREQUEST
FORM
Note: TheFamilyEducationalRightsandPrivacyAct:20USC1232(FERPA)requireswrittenpermissionfromstudentstohave
theirschoolrecordsandtranscriptsdistributed.
The New Jersey AdministrativeCode 12:41 et seq. which regulatesNJ Private CareerSchools,doesnotrequirethattheNJ
DepartmentofEducationorNJDepartmentofLaborandWorkforceDevelopment(DOL) maintain student records. Upon
receipt of this signed and notarized document, a search ofavailablerecordswillbeconductedonyourbehalf. Records
providedbyDOLwillbeunofficial.
Directions: A request for a copy of an Adult Student Transcript and/or records can only be
made
by the former
student. Please provide the requested information. Sign this document where
requested
and have your signature
notarized.Returnthe notarized form via email to [email protected].
Name:
Last 4 Digits of SSN#:
Name
of
School
Attended:
Location
of
School
Attended:
Dates
of
Attendance:
Vocational
Program
Attended:
Current
Address:
Current
Phone
Number:
Email
Address:
Name
at
Time
of
Enrollment
(if
different
from
above)
:
Please
forward
my
records
to:
BoardApplicationNumber
(ifapplicable)
:
I , herebycertifythattheinformationaboveis
correcttothebest
(PrintYourName)
ofmyknowledge,andIcertifythatIamtheformerstudentrequestingmyown
records.
Student’sSignature NotarySignature
DateofSignature
Questions or notarized forms must be submitted to the Training Evaluation Unit via email at [email protected].
DateofSignature
