Request of Student Records form

  • Printable version of Request of Student Records form available here.

    Previous School Address:??????

    Telephone:??????   Fax:??????

    Start Date:??????

    Please be advised that the following child who attended your school has transferred to the Enlarged City
    School District of Middletown, New York:

    Student's Name:??????

    DOB:??????   Grade:??????


    FOR OFFICE USE ONLY:For placement, please fax 845-326-1321 or email the following:
    ? Proof of Age
    ? Immunization Record
    ? Report Card
    ? Transcript/Disciplinary Records
    ? IEP (Individualized Education Program)


    Please forward all scholastic records, transcript/report card, test scores (i.e., Terra Nova, ELA, Math,
    NYSESLAT, NYSITELL), health records, birth certificate or other proof of age, disciplinary records and
    any other pertinent information concerning this child to:

     

    • Maple Hill Elementary School (Grades K-5) 491 County Route 78, Middletown, NY 10940
      Main Office: 845-326-1740 Fax: 845-326-1795 Nurse Office: 845-326-1735 Fax: 845-326-1796
    • Maple Hill Elementary School Annex at Truman Moon (Grades K-5) 53 Bedford Ave,
      Middletown, NY 10940
      Main Office: 845-326-1780 Fax: 845-326-1788 Nurse Office: 845-326-1860 Fax: 845-326-1775
    • Presidential Park Elementary School (Grades K-5) 50 Roosevelt Avenue, Middletown, NY
      10940
      Main Office: 845-326-1850 Fax: 845-326-1851 Nurse Office: 845-326-1860 Fax: 845-326-1862
    • William A. Carter Elementary School (Grades K-5) 435 East Main Street, Middletown, NY
      10940
      Main Office: 845-326-1711 Fax: 845-326-1723 Nurse Office: 845-326-1714 Fax: 845-326-1724
    • Monhagen Middle School (Grades 6-8) 555 County Route 78, Middletown, NY 10940
      Guidance: 845-326-1764 Fax: 845-326-1758 Nurse Office: 845-326-1676 Fax: 845-326-1675
    • Twin Towers Middle School (Grades 6 -8) 112 Grand Ave, Middletown, NY 10940
      Guidance: 845-326-1648 Fax: 845-326-1644 Nurse Office: 845-326-1638 Fax: 845-326-1636
    • Middletown High School (Grades 9-12) 24 Gardner Avenue Extension, Middletown, NY 10940 Main
      Office: 845-326-1530 Fax: 845-326-1605 Nurse Office: 845-326-1590 Fax: 845-326-1606
      • House 1 845-326-1536 Fax: 845-326-1621
      • House 3 845-326-1546 Fax: 845-326-1623
      • House 2 845-326-1541 Fax: 845-326-1622
      • House 4 845-326-1552 Fax: 845-326-1624

    Thank you for your consideration in this matter. Any questions, please contact Central Registration at 845-326-1300 Fax 845-326-1321 I hereby authorize the release of all the above named records:

    Signature of Parent or Guardian:??????

    Date:??????

    493936.1 6/2018