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

Surname: *

Given Name(s): *

Postal Address: *

Town/Suburb: *

Post Code:

Country (if not Australia): *

Home Phone:

Work Phone:

Fax Number:

Mobile Phone:

Email Address:

Relationship with Past Student: *

Other Relationship (if applicable):

Reason for Request (Family or Research Purposes):

Student's Family Name at School: *

Student's Given Name(s): *

Years Attended PMS (approximate if not sure): *

If you are human, leave this field blank.