EFFINGHAM COUNTY BOARD OF EDUCATION



EFFINGHAM COUNTY HIGH SCHOOL

1589 Highway 119 S • Springfield, Georgia 31329 • (912) 754-6404 • Fax: (912) 754-6893

TRANSCRIPT REQUEST FORM

(Please Type or Print)

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|FIRST NAME MIDDLE NAME LAST NAME MAIDEN |

|NAME |

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|DATE OF BIRTH (MM/DD/YY) DAYTIME PHONE NUMBER EMAIL ADDRESS |

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|STREET OR P.O. BOX CITY STATE |

|ZIP |

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|I UNDERSTAND THAT I AM RESPONSIBLE FOR SENDING MY ACT/SAT SCORES DIRECTLY FROM THE TESTING AGENCY TO THE COLLEGES. |

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|SIGNATURE OF STUDENT DATE (MM/DD/YY) |

|SIGNATURE OF PARENT OR GUARDIAN (IF STUDENT IS A MINOR) DATE (MM/DD/YY) |

|*This request must be signed and dated no more than ten days prior to being received by the Effingham County Board of Education. |

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|Please do not ask us to send transcripts to a college until you have applied to the college. |

|MAIL TRANSCRIPT TO: (PRINT COMPLETE ADDRESS) | |MAIL TRANSCRIPT TO: (PRINT COMPLETE ADDRESS) |

|Number of Copies Requested: __________ | |Number of Copies Requested: __________ |

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|City State ZIP | |City State ZIP |

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|MAIL TRANSCRIPT TO: (PRINT COMPLETE ADDRESS) | |MAIL TRANSCRIPT TO: (PRINT COMPLETE ADDRESS) |

|Number of Copies Requested: __________ | |Number of Copies Requested: __________ |

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|City State ZIP | |City State ZIP |

|PERSONAL PICK-UP (You must have a valid ID to personally pick up a transcript.) |

|Number of Copies Requested: __________ |

|Date and time you will pick up: _______________________________ |

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