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Saint Jerome Regional School 50 Meadow Avenue Tamaqua, PA 18252 REQUEST FOR RECORDS Dear , The following child/children have applied for enrollment to St. Jerome Regional School for the _________-________ school year. We require a review of all records before acceptance and are requesting for the following student(s): Grade: Grade: Grade: We respectfully request that you send the following records, at your earliest convenience via fax: -Student, Cumulative Record Card -Psychological Evaluations -Health/Dental/Immunization Records -Diagnostic Testing Results -Disipline Records/Other Relevant Data Thank you for your attention to this request. Sincerely, Amy M. Hannis-Miskar, Principal I, , hereby authorize the release of the above checked information concerening my child/children to St. Jerome Regional School.

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Saint Jerome Regional School 50 Meadow Avenue Tamaqua, PA 18252

REQUESTFORRECORDS

Dear,Thefollowingchild/childrenhaveappliedforenrollmenttoSt.JeromeRegionalSchoolforthe_________-________schoolyear.Werequireareviewofallrecordsbeforeacceptanceandarerequestingforthefollowingstudent(s): Grade: Grade: Grade:

Werespectfullyrequestthatyousendthefollowingrecords,atyourearliestconvenienceviafax:

-Student,CumulativeRecordCard-PsychologicalEvaluations-Health/Dental/ImmunizationRecords-DiagnosticTestingResults-DisiplineRecords/OtherRelevantData

Thankyouforyourattentiontothisrequest.

Sincerely,

AmyM.Hannis-Miskar,Principal

I,,herebyauthorizethereleaseoftheabovecheckedinformationconcereningmychild/childrentoSt.JeromeRegionalSchool.

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