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Studentrecordsrequest

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10 views1 page

Studentrecordsrequest

Uploaded by

moneymitchmike777
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Mail Completed Application Form To:

Student Records Request


New York State Education Department BPSS – 153 (1/18)
Bureau of Proprietary School Supervision
89 Washington Avenue, EBA 560
Albany, NY 12234
Or fax to: (518) 474-6543
Or email to: BPSSStudentRecordsRequest@nysed.gov

Section 126.9 of the Regulations of the Commissioner of Education requires that student permanent records shall be
maintained in a single file for each student for a period of not less than 20 years after the student completes the program.
A New York State school which ceases operation is required to provide for the transfer of these records to another school
or to the New York State Education Department. If the school you attended is still in operation, we do not have your
records. You must contact that school, even if it has changed location.

Please provide us with all the information requested below in order to make our search of the records as successful as
possible. Although we make every effort to retrieve student records of closed schools, some records were never sent,
some are incomplete, and some are not yet accessible. We will notify you of the outcome of our search, however please
allow six (6) weeks processing time.

Please Type or Print All Information. Thank you.


Current Student Name:

Student Name at Time of Attendance:

Social Security Number: Date of Birth:

Current Home Address: Phone Number:


Street: ( )
Apt. #:
City, State, Zip Code
School Name:

School Address:
Street:
City, State, Zip Code
Title of Program (Course of Study): Number of Hours:

Dates Attended: Graduated? (please check one)


From: To:  Yes  No
I authorize the New York State Education Department to forward my school records, if available, to the
following address: Check here if you need a duplicate copy sent to your home address.

Original Student Signature*: Date:

Please attach photocopies of all diplomas/ certificates of completion, report cards and/or grade reports that you
currently have in your possession.
*
If an individual other than the student is filing this form, an original letter of authorization signed by the student
is required due to the confidential nature of these records.

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