Confidential Records Request

CDC - Confidential Records Request

Please fill out the records request form below when requesting information concerning yourself or your child. We must have written notification in order to release any information.

This page is for requesting any information concerning parent/child. You, the person requesting the record, are the "Requestor".

Example: copy of social security cards, copy of birth certificate, or immunization records.

Completion of all fields is required.

Name of Record:
Date of Record:
Date of Request:
Name of Requestor:
Contact Phone:
Department:
Requestor's Email:
Purpose for request:


 

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Phone: 701-255-3285 Ext. 1392
Fax: 701-530-0621

http://www.uttc.edu/cdc/

Click here to view the UTTC Family Educational Rights and Privacy Act (FERPA) statement.

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