Records Release

It will take up to 10 business days to process requests and records will only be released with proper authorization.

Please complete the form below

Requesting:

Transcript Only

Immunizations Record Only

Academic Record

Other (describe below)

Other:

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Year(s) attended YBMC

Which years were you a student at YBMC?

Year graduated

If applicable

Name while attending YBMC (if different)

First Name

Last Name

SENDING RECORDS TO:

-Allow up to 10 business days for request to be processed-

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Section

Federal and State legislation requires that consent is needed for transfer of records beyond a third party. I hereby authorize YouthBuild McLean County to release an official school transcript as well as official administrative records. The above named student must sign this authorization form. I acknowledge that I have been advised of my right to inspect and copy records, challenge their contents, and limit my consent to designated records or designated portions of records. IF THE STUDENT IS NOT YET 18 YEARS OF AGE, THE AUTHORIZATION FORM MUST BE SIGNED BY PARENT/GUARDIAN. By typing my name below, I hereby authorize my consent in this e-form.

Student's Signature

First Name

Last Name

Date

today's date

YYYY

Parent's Signature

If not 18

First Name

Last Name

Date

YYYY

Records Release

Please complete the form below

Eduintel

youthbuild mclean county is a partner agency with local workforce area 14.

For More information and direction on accessing services available in the Local Workforce Area 14 visit: http://www.centralillinoishelps.com/