Certifications & Disciplinary Records Request

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Your Student ID Number:

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Your email address:

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DOB (YYYY-MM-DD):

Urgency of this report(Required):

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Information for Records Release

Dates of Attendance at West Chester University (YYYY-MM-DD) to (YYYY-MM-DD).(Required) This field is required.

If not indicated on the attached forms, please list the names, addresses, contact information (including email address) of EACH of the Institutions that you are requesting reports be sent to. If you want these records sent to you, please indicate how you would like these records sent.(Required) This field is required.

Additional Information, Requests, or Comments: This field is required.

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Your Information

Information for Records Release

Supporting Documentation

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