TRANSCRIPT REQUEST FORM - Carl Schurz High School

Carl Schurz High School

TRANSCRIPT REQUEST FORM

Name _________________________ _________________________ ___________________

Last

First

Middle

Current Address _________________________________________________________________ Street

________________________ City

_________ State

______________ Zip Code

Telephone Number (_____)______-______

Date of Birth __________________

Last Name While at Schurz (if different from above): ____________________________

Attended Schurz from __________________ to ___________________

Month & Year

Month & Year

Check one

____ Graduated

____ Did Not Graduate

Check Request

Send Official Transcript to the following College or University. $3 payment is enclosed for each request. _________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Mail Unofficial Transcript to the following address. $3 payment is enclosed for each request.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Your Signature _____________________________________

Date ___________________

Mail completed form to:

Carl Schurz High School Attn: Registrar 3601 N. Milwaukee Ave Chicago, IL 60641

For internal use only: ______________________________ Date received

__________________________ Date fulfilled

________________________ Fulfilled by

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