KEENE ISD
2021-2022
Request for Student Records
Revised April 2021
Date: ___________________________________
Student Name: ________________________________________Current Grade: ___________________
Social Security #: _______________________________________Date of Birth: ____________________
Has your child been retained? YES NO If yes, which grade? ___________________
PRIOR SCHOOL CONTACT INFORMATION
Name of last school attended: __________________________________________________________
City: ____________________ State: _____________________ Zip Code: ________________________
Phone #: _______________________________ Fax: _________________________________________
List any other school(s) student has attended last year or during the current school year.
Name of School(s): _________________________________ Phone #: ___________________________
Name of School(s): _________________________________ Phone #: ___________________________
The undersigned authorizes you to send the records of the above named student to the school
listed below.
Texas Schools: TREx
Private or Out of State Schools: Date mailed or faxed by KISD: ____________________
Records maybe mailed or faxed to:
Keene Elementary Keene Junior High Keene High School
ATTN: Rochelle Montgomery
P O Box 656
Keene, TX 76059
Phone: (817) 774-5312
Fax: (817) 774-5404
rmontgomery@keeneisd.org
ATTN: Kelly Ronning
P O Box 656
Keene, TX 76059
Phone: (817) 774-5311
Fax: (817) 774-5402
kronning@keeneisd.org
ATTN: Sarah Taylor
P O Box 656
Keene, TX 76059
Phone: (817) 774-5461
Fax: (817) 774-5401
staylor@keeneisd.org
PLEASE INCLUDE THE FOLLOWING RECORDS:
social security card
birth certificate
complete grades to date
STAAR scores (if TX School) or other test scores
complete standardized test results and related data
other educational records (ESL original, GT, Special Ed, 504, Dyslexia, PGP)
other information which may assist in placing this student
_______________________________ ___________________ ________________ __________
Parent/Guardian Signature Date School Official Signature Date
