NEISD BANNERRequest for Copies or Original Credentials
(Service Records, Transcripts, and/or Teacher Certificate)



This form is to be used by current or former employees only and should not be used as an open records request. Please complete the following information. Once you’ve completed this form, click on the “SUBMIT” button at the bottom of the page. Should you need assistance completing this form, please contact Human Resources at 804-7025.

**REQUESTS USUALLY TAKE 7-10 BUSINESS DAYS TO PROCESS**


Please complete the following identifying information:

First Name: Last Name:
Social Security Number: Telephone #:
Position:
NEISD Employment Dates: From~ To~

Was there a break in service?    Yes   No
Mailing Address:
City: State: Zip:

Check documents you are requesting:
Teacher Certificate
Transcripts
Service Record(s)
Other:

Check appropriate box:
I will pick up the documents when they are ready.
      Daytime telephone number:
FAX the documents to: ATTN:
Mail documents to the mailing address listed above.
Mail documents to the address listed below. (Complete address below)

Name:
Address:
City:
State: Zip



Date of Request: May 13, 2008