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#: _____________________ Phone # ______________________

Student’s Current Address:  _____________________________________________________________________

                                                _____________________________________________________________________
 
     Email address:   _____________________________________________________________________

Specific Information Wanted from Student File: Unofficial Transcripts: Mailed or E-mailed              
            Official Transcripts:    Fill out following section	  

Official Transcript to be sent to:

Institution/Company:  ___________________________________________________________________________
                    
Address:  _____________________________________________________________________________________ 
 
Secured Fax/E-mail to receive official transcripts: ___________________________________________________
               
Attention to: __________________________________________________________________________________

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

_____________________________________________________________________________________________

3rd Party Requests: Submit a copy of the student release form authorizing the party to obtain the requested information. The request must be accompanied with a $10.00 Company Check (3rd Party requests Only) or Money Order made out to Private Postsecondary Education.

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.