Transfer of Records Request

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#666633" TEXT="#080000" bgproperties="fixed" background="087005a2ddvuvs.gif"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Times New Roman" ><B>El Shaddai Ministries of Florida, Inc.</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="El Shaddai Ministries of Florida, Inc."><U><B>home</B></U></A></div> <bR> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#999966" TEXT="#080000"> <div> <A HREF="id25.htm" TARGET="_top" TITLE="Enrollment Requirements"><U>Enrollment Requirements</U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="Parent/Teacher Responsibility"><U>Parent/Teacher Responsibility</U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="Statement of Faith"><U>Statement of Faith</U></A></div> <div> <A HREF="id41.htm" TARGET="_top" TITLE="Affirmation of Commitment"><U>Affirmation of Commitment</U></A></div> <div> <A HREF="id29.htm" TARGET="_top" TITLE="Personal or Pastor Reference"><U>Personal or Pastor Reference</U></A></div> <div> <A HREF="id30.htm" TARGET="_top" TITLE="Student Enrollment Form 2001/2002"><U>Student Enrollment Form ~ 2001/2002</U></A></div> <div> <B>Transfer of Records Request</B></div> <div> <A HREF="id33.htm" TARGET="_top" TITLE="Curriculum List"><U>Curriculum List</U></A></div> <div> <A HREF="id32.htm" TARGET="_top" TITLE="Quarterly Reports"><U>Quarterly Reports</U></A></div> <div> <A HREF="id42.htm" TARGET="_top" TITLE="High School Florida Course Codes"><U>High School - Florida Course Codes</U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="Testing Evaluation Info"><U>Testing & Evaluation Info</U></A></div> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Transfer of Records Request</I></div> <div> <I><B><U>El Shaddai Ministries of Florida, Inc.</U></B></I></div> <div> 11639 Huggins Street ~ Leesburg, FL ~ 34788 ~ 352-742-2401~ ElShaddaiAcademy@cs.com</div> <bR> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>REQUEST FOR STUDENT RECORDS</B></div> <bR> <bR> <bR> <div> Former School:</div> <bR> <bR> <div> __________________________________</div> <bR> <bR> <div> __________________________________</div> <bR> <bR> <div> __________________________________</div> <bR> <bR> <bR> <div> ATTN:  Records Office</div> <bR> <bR> <div> The following student has enrolled in our school:</div> <bR> <bR> <div> _________________________________________      __________      ___________________</div> <div> Name of Student                                                                                     Grade                       Date of Birth</div> <bR> <bR> <bR> <div> Please include:</div> <bR> <div> 1.  Up-to-date transcripts including dates of entry/withdrawal, days of attendance, grading scales, test scores, all subjects and grades to date of withdrawal (cumulative records).</div> <bR> <div> 2.  Any psychological or special placement data.</div> <bR> <div> 3.  Health records including physicals and immunization records or waivers.</div> <bR> <div> Please send records to the above address.</div> <bR> <bR> <div> ______________________________________                    Date: ____________________</div> <div> Parent Signature</div> <bR> <bR> <div> ______________________________________                    Date: ____________________</div> <div> Viola K. Moss, Registrar</div> <div> FDOE School #351843</div> <bR> </td> </tr></table></body>