TRANSCRIPT and CA-60

Cumulative Student Record

REQUEST

From:

• Name: ____________________________________________________

• Address: __________________________________________________

• Phone: ___________________________________________________

Student's name: _______________________________________

Student' date of birth: ___________________________________

Student's address: ______________________________________

Name of last, or school attending and grade: _________________________________________

I AUTHORIZE the school or district below to release all academic records,

transcripts and test scores, including the cumulative folder (CA60); with

Elementary (CA60A); Secondary (CA60B); Health (CA60C); Reading

(CA60D); Special Help (CA60 E & G) including guidance, remedial, special

education [IEP & 504], social, conferences, etc.; Test Tabulation (CA60T);

& Records (CA60P, a -o), including vocational and guidance / EDP.

School or district name: ___________________________________

Attention: ____________________________________________

Address: _____________________________________________

Phone: ______________________________________________

Print name:__________________________ Date: ____________

_____________________________________

Signature of parent, guardian, or 18-year-old student