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Application to Release Past Student Records

Historical and Museum Committee

Roberts Road Subiaco WA 6008


I wish to apply for the release of Past Student records as shown below.

* indicates required field

Applicant

Surname:*
Given Name(s):*
Postal Address :*
Town/Suburb:*
Post Code:*
Country (If not Australia):
Home Phone:
Work Phone:
Mobile Phone:
Email Address:
Relationship with Past Student:*
Other Relationship (if applicable):
Reason for Request (Family or Research Purposes):

Past Student

Student's Family Name at School:*
Students's Given Name(s):*
Years Attended PMS (approximate if not sure):*
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90 Roberts Road, Subiaco Western Australia 6008
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