Teacher/Professional Staff
Service Record Request Form
PERSONAL INFORMATION
FULL NAME:
MAIDEN: LAST 4 #SSN:
EMAIL: PHONE:
MAIL SERVICE RECORD TO: ATTENTION TO:
STREET ADDRESS:
CITY:
STATE:
ZIP
CODE:
EMAIL ADDRESS: PHONE:
DATES OF SERVICE: List your previous schools, beginning with the most recent.
SCHOOL NAME(S) DATE:mm/yy-mm/yy FT/PT GRADE(S)
Please allow ten days to 2 weeks for processing of service records.
Send request to asims@archgh.org
CSO Use Only:
DATE RECEIVED: DATE COMPLETED:
Due to COVID19 we are only emailing records at this time.