Transcript Release Form-Former Students
[Pages:1]Clarkstown High School South School Counseling Center 31 Demarest Mill Road West Nyack, NY 10994
845-624-3413 845-624-3418 Fax
Transcript Release Form-Former Students
___________________________ Date
___________________________ Telephone #
Date of Graduation _______________________
OR
Last Attended
_______________________
________________________ ___________________________
Date of Birth
Social Security #
_______________________________ ____________________________ ___________________________
Last Name
First Name
Maiden Name
________________________________________________________________________________________
Address
City
State
Zip
Are you requesting SAT scores be sent? (If they have been released to South HS by you)
Yes
No
Please send a copy of my records to: (Please give full address of college/university)
____________________________________________ Student or Guardian's Signature
................
................
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