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TRANSCRIPT RELEASE FORM
STUDENT'S NAME________________________________________
GRADUATING CLASS OF________________(Year)
SCHOOL ATTENDING/ATTENDED________________________________
The Elementary and Secondary Education Act of 1974 requires that you be notified that your record or transcript is being forwarded to another educational institution. Rather than delay the mailing of a transcript and adversely affect your application, we are asking that you complete and return the following form:
I give permission to _______________________ to release the following information
(School Name)
_____a. Send transcripts to any of the following: federal, state local education agency,
or institution of higher education
_____b. Send transcripts and/or levels of achievement in high school courses or
attendance records to employers requesting information for employment
purposes.
_____c. Send information only on specific request of the student or parent to the address listed below:
____________________________________________
____________________________________________
____________________________________________
__________________________ __________________
Signature of parent or graduate Date
Please read, complete and return this form to the school counselor at the school the request is being made.
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