Form CAS-16 (PD407-169) "Request for School Records" - New York City

What Is Form CAS-16 (PD407-169)?

This is a legal form that was released by the New York City Police Department - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2019;
  • The latest edition provided by the New York City Police Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CAS-16 (PD407-169) by clicking the link below or browse more documents and templates provided by the New York City Police Department.

ADVERTISEMENT
ADVERTISEMENT

Download Form CAS-16 (PD407-169) "Request for School Records" - New York City

1514 times
Rate (4.7 / 5) 106 votes
CAS – 16
REQUEST FOR SCHOOL RECORDS
PD 407-169 (Rev. 08-19)
List # ________________
Exam # _______________
Character Assessment Section
235 E. 20th St.
New York, N.Y. 10003
Date: _________________
_________________________
_________________________
_________________________
Attention: School Records
To Whom It May Concern:
Pursuant to the written communication below, it is requested that the New York City Police Department be furnished
information contained in the school records of the student named below who is a candidate for appointment to this
Department.
Specifically, it is requested that the information requested on the reverse side of this letter, including any pertinent
comments from former teachers or other school personnel, be furnished as it appears on your records.
Your prompt attention to this matter will be appreciated.
Sincerely,
__________________________________
Investigator, Squad #
AUTHORIZATION
I hereby authorize the release of any and all information contained in my school records or known to school personnel
and that such information and/or records be disclosed, furnished to, and/or examined by the New York City Police
Department for the purpose of determining my eligibility for appointment to the New York City Police Department. This
Authorization shall remain in effect until canceled by me in writing.
I acknowledge by this authorization that I release you from any obligation or liability in the disclosure of the contents of such
files and the professional observations or opinions contained therein.
_________________________________________
_____________________________________________
Full Name – Printed
Candidate’s Signature
Date Of Birth: ______________________________
Attended School From: ______________________
To: ______________________
Social Security Number: _____________ – _________ – ______________
CAS – 16
REQUEST FOR SCHOOL RECORDS
PD 407-169 (Rev. 08-19)
List # ________________
Exam # _______________
Character Assessment Section
235 E. 20th St.
New York, N.Y. 10003
Date: _________________
_________________________
_________________________
_________________________
Attention: School Records
To Whom It May Concern:
Pursuant to the written communication below, it is requested that the New York City Police Department be furnished
information contained in the school records of the student named below who is a candidate for appointment to this
Department.
Specifically, it is requested that the information requested on the reverse side of this letter, including any pertinent
comments from former teachers or other school personnel, be furnished as it appears on your records.
Your prompt attention to this matter will be appreciated.
Sincerely,
__________________________________
Investigator, Squad #
AUTHORIZATION
I hereby authorize the release of any and all information contained in my school records or known to school personnel
and that such information and/or records be disclosed, furnished to, and/or examined by the New York City Police
Department for the purpose of determining my eligibility for appointment to the New York City Police Department. This
Authorization shall remain in effect until canceled by me in writing.
I acknowledge by this authorization that I release you from any obligation or liability in the disclosure of the contents of such
files and the professional observations or opinions contained therein.
_________________________________________
_____________________________________________
Full Name – Printed
Candidate’s Signature
Date Of Birth: ______________________________
Attended School From: ______________________
To: ______________________
Social Security Number: _____________ – _________ – ______________
Candidate Name: ____________________________________Social Security Number: ___________________________
Dates Of Attendance: __________________________ to __________________________________
Day / Evening
Degree, Diploma, Or Certifi cate Received: _______________________________________________________________
Previous School: ___________________________________________________________________________________
School Transferred To, If Any: _________________________________________________________________________
Truant, Lateness, Disciplinary Record: _________________________________________________________________
Home Address: ____________________________________________________________________________________
Date Of Birth: ________________________________
Place Of Birth: ________________________________________
PERSONALITY RATINGS – CHARACTER TRAITS
Please check applicable box for overall rating in each category.
POOR
FAIR
GOOD
EXCELLENT
            
Dependability
            
Cooperation
            
Courtesy
            
Appearance
EXPLANATION OF TERMS
DEPENDABILITY: Student has a sense of duty, tries harder by himself, meets obligations promptly, and is trustworthy.
COOPERATION:
Student serves the school, teachers, fellow students, and works together with others to improve
the group.
COURTESY:
Student has good manners, is considerate in dealing with others, and is obliging and disciplined.
APPEARANCE:
Student has good posture, neat habits about person, property, and work, and is neat in dress.
Is there any disciplinary record or other confidential information on file? Yes or No ___________________. If there is,
please elaborate below or if you would prefer to have the investigator contact you personally, please indicate below.
___________________________________________________________________________________________________
School Representative
Title
Telephone Number
Date
Page of 2