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Records Request Form

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

Date of Request*

Answer Required

Your First Name*

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Middle Name

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Last Name*

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Your Address (current)*

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City*

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Zip/Postal*

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Your Email*

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Other Names Used While in School

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Date of Birth*

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Year of Graduation*

enter "0" if a non-graduate

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Contact Phone Number*

Number Required

Information Requested*

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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