Groveport Madison Schools	Parent/Guardian Use Only District Service Center
4400 Marketing Place, Suite B Groveport, OH 43125 614-491-8288 www.gocruisers.org

Request for Student Records
for Enrollment in Groveport Madison Schools

This Request for Student Records is intended for use by a parent/guardian interested in enrolling their child in Groveport Madison Schools.

Student’s Name:
First	Middle	Last

Date of Birth: ___________________________________	Grade Level: 	

·	Information requested from the student’s current/previous school includes: ·	Student’s Birth Certificate
·	Immunization Records (including TB test results, if applicable) ·	Unofficial Transcript or Last Report Card
·	IEP/ETR/504 Plan
·	Court-issued Custody Documentation, if applicable

Parent Signature: _______________________________________________ Date:

Current/Previous School District:
This Request for Student Records does not withdraw the above-listed student from your school district. Once the student has been enrolled in Groveport Madison Schools, and attends his/her first day of school, you will receive an “official” records release with the information required by Ohio law to withdraw the student from your school district.

For more information, call our Enrollment Office, at 614-491-8288.

The mission of Groveport Madison Schools is to build a community of learners, leaders and responsible citizens. _______________________________________________

Every Student, Every Lesson, Every Day