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Records Request Form

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

Date of Request*

Answer Required

Your First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Your Address (current)*

Answer Required

City*

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Zip/Postal*

Answer Required

Other Names Used While in School

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Date of Birth*

Answer Required

Year of Graduation*

enter "0" if a non-graduate

Answer Required

Contact Phone Number*

Number Required

Information Requested*

Answer Required

Official Transcript/ACT (signed & sealed)

Unofficial Transcript (sent to your address)

Immunization Records

Copy of Birth Certificate

Other:

Number of Copies*

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Send Records To:*

enter your name, school name, etc

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Street Address*

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City*

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Zip/Postal*

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Fax Number

Number Required

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required