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Request for student information and records

Part 1: Instructions

The information required on this form is necessary to verify and protect student records from being accessed by unauthorized individuals. The information contained in this request will be treated as confidential except where required otherwise by law.

Please complete all information in full and then finalize the process by submitting this form to or by fax to 844.811.6354.

You may also return this form and any attachments by mail to:

530 Seventh Avenue, Suite 501

New York, NY 10018

Where applicable attach a copy of written consent to obtain information about the student for which this request is being made.

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