Records Request

Student Name(Required)

First Last

DOB(Required)

MM slash DD slash YYYY

Grade(Required)

Reason for Request(Required)

New School of Attendance

Other

Start Date(Required)

MM slash DD slash YYYY

Please explain reason for request(Required)

Requestor's Name(Required)

Requestor's Title(Required)

Email(Required)

Enter Email Confirm Email

Name of school(Required)

Mailing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Attention:(Required)

Enter the name of the person or the department to receive records. Example: Office of Admissions

Records Requested(Required)

ELPAC Scores (if applicable)

IEP (if applicable)

Exit Grades/Transcripts

Discipline Records

Health File

504 Plan (if applicable)

Immunization Records

Birth Certificate

GATE Program (if applicable)

Epic California Academy

100 South Anaheim Blvd., Ste. 150
Anaheim, CA 92805
PH: 657.220.1000

HOURS M-F 9 a.m. to 4 p.m. EMAIL info@epiccalifornia.org

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