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Records Request Form

Please complete the form below. Required fields are marked with an asterisk *

Date of Request*

Answer required for "Date of Request"

Your First Name*

Answer required for "Your First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Your Address (current)*

Answer required for "Your Address (current)"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Other Names Used While in School

Answer required for "Other Names Used While in School"

Date of Birth*

Answer required for "Date of Birth"

Year of Graduation*

enter "0" if a non-graduate

Answer required for "Year of Graduation"

Contact Phone Number*

Number Required

Information Requested*

Answer required for "Information Requested"

Official Transcript/ACT (signed & sealed)

Unofficial Transcript (sent to your address)

Immunization Records

Copy of Birth Certificate

Other:

Number of Copies*

Answer required for "Number of Copies"

Send Records To:*

enter your name, school name, etc

Answer required for "Send Records To:"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Fax Number

Number Required

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"