Arizona State Board for Private Postsecondary Education

1400 W. WASHINGTON, ROOM 260
PHOENIX, ARIZONA 85007
(602) 542-5709

STUDENT RECORD REQUEST FORM

Student Name: ______________________________________________   Date: __________

Correct Name of Closed School: ___________________________________________

Dates of Enrollment/Graduation Date: ________________________________________

Program Enrolled: ________________________________________________________

Campus Location (Address): _____________________________________________________

Name (printed legibly) that Student used while attending the closed school:

____________________________________________

Student’s social security number or student ID#: ___________________________

Student’s current address: 

________________________________________________________________________

________________________________________________________________________

Phone #: ________________________________

Email address: __________________________________________________________

Specific Information Wanted from Student File: 

Student’s signature (this authorizes the release of confidential information.) 

________________________________________________________________________

If request is being made by a party other than the student, submit a copy of the student release form authorizing the party to obtain the requested information.

Processing Fee: Complete this form and return it with a $10.00 money order made out to Private Postsecondary Education to the address above.

Processing Time and No Guarantee: Please be advised that the average processing time is three to six weeks. The State Board cannot guarantee that a student record can be found for every student.