Please use the form below to request medical clinic, residential treatment or other records from your time with The William George Agency. Please fill out “special information” if you have specific instructions. Kindly allow 48 hours for routine requests.
NOTE: this form is for former resident requests. If you are a former staff member and looking to obtain employment verification, please contact the Human Resources department directly. Phone: 607-844-6395
NOTE: if you are interested in obtaining a transcript, graduation verification, immunization or other school-related records such as IEP or other testing, please complete the form on the GJR UFSD website.
NOTE: if requesting Medical Clinic records, an Authorization for Release of Health Information form is required and will be collected after a staff member reaches out to you. Click here to download and get started on the form.
Once your request has been received, you will be contacted at the phone number you provide below by a staff member who will complete your request.
Fields marked with an * are required