Crossroads Christian School, Inc.

PO Box 295 / Crestview, Florida 32536 / 850-423-1291

Florida Department of Education #460021

Request For Student Records

Former School's Name:_______________________________________________

Address:____________________________________________________________

City:____________________________________ State: _______Zip:________ 

Phone Number:_______________________________

Name of Student:_____________________________________________

Date of Birth:_______________________________________________

Grade:___________________________

Please include:

• Up-to-date transcripts including dates of entry/withdrawal, grading scales, test scores, all subjects and grades to date of withdrawal (cumulative records).
• Any psychological or special placement data.
• Health records including physicals and immunization records or waivers as well as birth certificates.

Please send records to:

Crossroads Christian School, Inc.

PO Box 295

Crestview, Florida 32536

Parent Signature: _______________________________________________Date:___________

Registrar:________________________________________________Date:___________