SR #:		
                     		        HOUSTON INDEPENDENT SCHOOL DISTRICT	                
		     	                               REQUEST TO TRANSFER RECORDS                                        Page ___ of ___
In accordance with the HISD RETENTION SCHEDULE, the department/school listed below requests to transfer the following records to the District Records Center (DRC):
RETENTION
SCHEDULE
NUMBER	
DESTROY
DATE 	 
RECORD SERIES TITLE
DESCRIPTION AND / OR RANGE	
DATE RANGE
 FROM  / TO	DEPARTMENT
BOX
NUMBER	RECORD
CENTER
LOCATION	

				

				

				

				

 				

				

  				

 				

				

SCHOOL / DEPT: ______________________________________    	        TELEPHONE NO.: __________________________

PREPARED BY: _______________________________________    	        TOTAL NUMBER OF BOXES
							           	        TO BE TRANSFERRED: _______________
APPROVED BY: _______________________________________    	
		(Department Head - full name)		        DATE: _____________________________

RECORDS MANAGEMENT DEPT. USE ONLY	
TRANSMITTAL RECEIVED BY:

	DATE 
	
RETENTION REVIEWED BY:                 

	DATE 
	
RECORDS TRANSFERRED BY:

	DATE: