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: ___________________________

Student’s current address: 

________________________________________________________________________

________________________________________________________________________

Phone #: ________________________________

Email address: __________________________________________________________

Specific Information Wanted from Student File: _______________________________

Official Transcript to be sent to:

Institution/Company:  _____________________________________
                    
     Address:  _____________________________________
 
      	       _____________________________________

Attention to: _____________________________________

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. The fee is for processing your request and is non-refundable regardless of the outcome of the records search. 

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.