Goose Creek Consolidated Independent School District

Request for Video Surveillance for the 2020-2021 School Year

Requester's Namerequired
Address:required
City/State/Zip:required
Email:
Home Phone:
Cell Phone:
Work Phone:
According to the above definitions, I (we) qualify as a:required
Name of Student:
Student ID#:
Campus Name:required
Location of requested surveillance:required
Please insert your electronic signature or type your name to represent your signaturerequired
Date:required
After submitting the form, the District will contact you regarding the status of your request within seven (7) school business days after receipt of the completed Form A by the person to whom it must be submitted.