Clover School District Records Request Form

 
 
  
This records request form can be used by both individuals and businesses. Potential employers should enter the applicant's information in Section One and then enter the employer's (or school's) mailing address in Section Two. The last four digits of the individual/applicant are required as verification on this form.

 
 
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Please provide the name used while attending school.
 
   
 
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Please provide the name used while attending school.
 
   
 
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Please provide the name used while attending school.
 
   
 
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SECTION ONE: (Individual/Applicant information)
Please complete this section of the request with information that is valid today.

   
 
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SECTION TWO: (Potential Employer, College, etc.)If you would like your requested documents to be mailed to a different address (i.e. potential employer, college, university, etc.), please provide the contact name/department and complete mailing address below.
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
   
 

AUTHORIZATION NOTIFICATION:
I hereby authorize the Student Records Department of the Clover School District to release information concerning my records. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other part or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act.

Enter the last 4 digits of your SSN to represent your online signature.
   
 
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(If provided, a verification will be sent when your request is completed.)
 
   
 
 
 
 Done