Request for Documentation

Request for Documentation

To be complete by active students only
In accordance with the Family Education Rights and Privacy Act of 1974 it is necessary for officials at Center for Allied Health Education and its agents to have written consent from a student in order to release information from the student's records to any source outside the Center, the exception being directory information.

The Request for Documentation form is completed by a student who would like to request a student letter, transcript or to have documentation from an outside agency be completed by the Administrative Office. By completing the form a student provides authorization to Center for Allied Health Education to disclose the information identified below.

Normal processing time is a minimum of three business days. You will be emailed once your request has been completed.
Program Name*
Cohort*
Student Name*

First NameLast Name
Last four digits of your Social Security Number*
E-mail Address*
I would like to request the following: *

Student Enrollment Letter (PDF Emailed)Unofficial TranscriptFinancial StatementComplete the Attached DocumentationComplimentary Transcript for Pending GraduatesOther
Students can access their Unofficial Transcript through their Orbund student portal.
Students can access their Financial Statement through their Orbund student portal.
Recommendation Letter From:
Name of Employee
I would like to:*

pick up my documenthave the office email the document to me
Name: *

First NameLast Name
Email:*
example@example.com
Forward documentation to:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Documentation to be Completed:

Documentation must be a scanned PDF, Microsoft Word or Microsoft Excel document, NOT a picture. For a free scanning app for your phone click the link below:

https://acrobat.adobe.com/us/en/acrobat/mobile-app/scan-documents.html
Upload a File

Cancelof
Student's Signature*

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Enter the message as it's shown*
The following notice will be provided to the persons or entities identified above:
The information disclosed to you is governed by the provisions of the Family Educational Rights and Privacy Act. Therefore, the disclosed information may be used only for the purposes identified by the student and may not be re-disclosed to others without specific written authorization from the student.
Date Completed:_____________________________
Completed by:_______________________________
Was the student emailed?
Should be Empty: