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Transcript/Immunization Request Form-For Outside Investigative Agencies Only
Please allow 10-15 business days to fulfill this request. At this time the process could possibly be longer than normal. KGCS is in the process of digitization of files. Thank you for your patience. Send all student release to
cnorris@kgcs.k12.va.us
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* Indicates required question
Email
*
Your email
Name of Requesting Agency
*
Your answer
Date
*
MM
/
DD
/
YYYY
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student Maiden Name
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Student Graduation Year
*
Your answer
Student Withdrawal Year
*
Your answer
Are you requesting a transcript or immunizations record?
*
Immunization
Transcript
Other:
Required
Requesting Agency's Current Telephone (Provide a current telephone number where you can be reached)
*
Your answer
Requesting Agency's Current Email (Provide a current email address)
*
Your answer
How would you like to access your record(s)?
*
By Fax (Please fax a copy of the student release form for identification)
By Mail
Please provide the fax number or email you would like the transcript sent to:_________________________
Other:
Required
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