Holland Public Schools - DOC by dSJb4Al3

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									                                         Holland Public Schools
                                       Request for School Records
Date:

         Names of Children                                          Grade                        Birthdate




The student or students listed above are transferring from (please fill in the name of the last school attended)


                           Name of School District

                           School Name

                           Street Address

                           City, State & Zip

                         School Phone Number                                 School Fax Number

Parent’s Permission: I hereby grant permission for the school listed above to transfer the records of my
student(s) to the Holland Public school indicated below. Please send all records (academic test scores,
cumulative record, health and immunization, special education records, test results and transcripts).


   Holland ECC                                    East K-7 School                             Jefferson K-7 School
                                                          th                                         th
925 Central Avenue                             373 East 24 Street                          282 W. 30 Street
Holland MI 49423                               Holland MI 49423                            Holland MI 49423
616-494-2650/Fax: (616) 393-7653               (616) 494-2425 / Fax: (616) 355-0674        (616) 494-2500 / Fax: (616) 393-7569

   Holland Heights K-7 School                      West K-7 School                            Holland High School
           th                                              th                                    th   th
856 East 12 Street                             500 West 24 Street                              (8 – 12 )
Holland MI 49423                               Holland MI 49423                            600 Van Raalte Ave.
(616) 494-2750 / Fax: (616) 393-7566           (616) 494-2350 / Fax: 616-393-7544          Holland MI 49423
                                                                                           (616) 494-2200 / Fax: (616) 394-2441

                                                                                                           th     th
                                                                                              VR Tech (8 – 12 )
                                                                                           461 Van Raalte
                                                                                           Holland MI 49423
                                                                                           (616) 494-2600 / Fax: ((616) 393-7652




Date                                                      Signature of parent, guardian, or student 18 years or older

Holland Public Schools does not discriminate on the basis of race, color, religion, sex, national origin, age, height, weight, marital
status, handicap, disability or limited English proficiency in any of its programs or activities. Inquiries regarding the district’s
nondiscrimination policies should be directed to: The Director of HR, Holland Public Schools, 156 W 11th Street, Holland, MI 49423.
Phone: 626-494-2025.

								
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