Release of Student Temporary File

Release of Student Temporary Record

The records that are being requested are irreplaceable. They can be released only upon Landmark’s receipt of this signed and dated release form. The release must be signed by the student if the student is eighteen (18) years of age or older. If the student is less than eighteen years of age, or if incapable, a legal guardian must sign the release.

Please indicate your choice below. If you choose to have these records mailed, Landmark cannot assume responsibility for their loss. We will mail these records via certified mail with a return receipt requested. Due to the expense, we require payment along with this form.

Student/Alum First Name*

Student/Alum Last Name*

Method of Release*I will pick up the records.Please email records to the email address listed.Please mail records to the mailing address listed on this form. There will be a fee of $20.00 (US). (+$20.00)

How would you like your record sent to you?

When will you pick up the records?*

Please allow 1 week from today’s date.

Email*

Street Address*

Town/City*

State

Country*

Postal Code*

Ownership Acknowledgement*I assume ownership of the above-named student’s records from Landmark School. I understand that these are original records, that Landmark will NOT maintain copies of these files, but that Landmark will maintain a copy of the academic transcript for sixty years following graduation or withdrawal.

Release Acknowledgement*I release Landmark School from all obligations and responsibilities concerning further maintenance of these records and I assume full responsibility for said records.

Signature*

(must be student if 18 years or older - or legal guardian)

Today's Date*

Date of Graduation/Withdrawal*

Amount$0.00

Payment Method:*

Payment Notes/Additional Info:

Name Associated with Payment:*

Email Associated with Payment:*

Pay with:*

Questions? Email [email protected].

Registrar

Release of Student Temporary Record

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