Records Request Form

 
Page 1 of 1
 
 Jefferson City Public Schools Records Request Form 
If you would like to request records from Jefferson City High School, JCAC, or Simonsen please fill out this form COMPLETELY. **All GED requests are handled by DESE at 573-751-3504.**

 
  Please note: This form does not work in Internet Explorer
   
1.
*
 
   
2.
*
 
   
3.
*
 
   
4.
 
   
5.
*
 
  
  
  
  
  
  
  
  

    
   
6.
*
 
   
7.
 
   
8.
Due to construction in the JC Building this summer, pick up service of records is not available.
Enter at least 1 response.
 

 

 

 
   
  Signature of Requesting Person (must be requesting person unless 17 years or under):
   
9.
*
 
   
10.
 
   
 
 
 
 Done  Save  Cancel