Service Records Request

Required

Name (Please enter the name you had while employed)required

First Name

Last Name

Last 4 of SSNrequired

Must contain only numbers

Begin Employment Daterequired

Must contain a date in M/D/YYYY format

End Employment Daterequired

Must contain a date in M/D/YYYY format

Where would you like these records sent?required

Your Email Addressrequired

Contact Namerequired

First Name

Last Name

Contact's Email Addressrequired

AUTHORIZATION NOTIFICATION:

By checking this box, I agree to the electronic transfer of my Service Records from Coldspring-Oakhurst CISD. 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 the authority of Public Law 93-380, Educational Rights and Privacy Act.

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Service Records Request

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