This is an official request for a copy of student records. The information contained in this request should be considered private. Please complete all information in full and then finalize the request process by clicking 'Update Fees - Prepare For Checkout' or 'Proceed to Checkout' at the bottom of the form.  The information required on this page is necessary to verify and protect your school record from being accessed by unauthorized individuals.  

 

Education verifications will be delivered via email to the email address entered on the application below.

 

You will receive emails from scribOnline@scribsoft.com to notify you of the status of your request.  It is important you read those emails carefully as additional information may be required to process your request.

 

ACCESSING THE ORDER TRACKER:  Once the request has been submitted, you will be directed to a confirmation page which contains the link to the Order Tracker.  You will also receive a link to the Order Tracker via email from scribonline@scribsoft.com.  To access the Order Tracker, you will enter your email address, order number and password.

Name While Attending School:

Information Related To Your Birth:

Your Last Great River Connections Academy School of Attendance:

Current Name / Requester Name:

Current Residence Address: (this may be different than the mailing address)

Current Mailing Address: (if different from residence address)

Telephone Number: (###-###-####)

Driver's License: (or other State Issued ID)

Email:



Documents Will Be Delivered To: please enter the delivery addresses
Name Attention Addr 1 Addr 2 City State Zip Country # of Copies

Reason(s) for Request of Student Record:


Select The Information Type(s) Requested:


Total Fee:
$0
AUTHORIZATION NOTIFICATION:
My initials below constitute an electronic signature and authorizes Great River Connections Academy to release information and / or my student records and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the records will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other party or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act.
 
I understand that an incomplete form will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.
Please enter your e-Signature


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