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Intent to Enroll Records Request

For Students Over Age 18
I,
Student Name
First
, am age 18 or over, and have been enrolled at Map Academy for the 2018-19 school year. Pursuant to the provisions of 603 CMR 23.07 (5), I request that all of my records be sent as soon as practicable and within ten days to:

Map Academy Charter School
6 Main St. Ext Suite 3169
Plymouth, MA 02361

Further, I grant Map Academy the ability to submit this request and receive these records on my behalf.
Signature:
Signature
Date:
Date

For Parent of Student Under Age 18
I,
Parent Name
First
, am the parent of
Student Name
First
who has been enrolled at Map Academy for the 2018-19 school year. Pursuant to the provisions of 603 CMR 23.07 (5), I request that all records for this student be sent as soon as practicable and within ten days to:

Map Academy Charter School
6 Main St. Ext Suite 3169
Plymouth, MA 02361

Further, I grant Map Academy the ability to submit this request and receive these records on my behalf.
Signature:
Parent Signature
Date:
Date