LOUDOUN COUNTY PUBLIC SCHOOLS



FREEDOM HIGH SCHOOL TRANSCRIPT REQUEST FORM(CEEB Code: 472-110)Please give this form and your Senior Worksheet to Ms. Studenick in School Counseling OfficeSTUDENT NAME: _____________________________COUNSELOR:_____________________I hereby request that a transcript of my scholastic record be sent to the following schools,organizations or scholarship sponsors.**College Application Decision Type KeyDelivery Method KeyRegular (R)Early Action (EA)Electronic Rolling (RO)Other (O)Common Application Early Decision (ED)Mail **College ApplicationDecision Type (see KEY above)Application DeadlineSchool, Organization, or Scholarship SponsorDelivery Method(Circle One)Who is writing your teacher rec?CounselorRec Request?FOR OFFICE USE ONLYYESNODate InDate Out *There is a 15 school day minimum to process requests for transcripts*It is the student’s responsibility to request standardized test scores to be sent directly to each college(AP, SAT, SAT II ) (ACT )*7th semester (mid year) grades will automatically be sent to all colleges listed at the end of first semester*A final transcript will be sent to the college selected on your Senior mon App:If requesting a transcript for a Common App school, you must (please check):31432511747500Complete the FERPA waiver on the common app3143257747000Match your common app in Family Connection5715013208000By checking this box, I waive my right to access my recommendation, and I understand I will never see any recommendation.Student’s Signature DateParent’s Signature (if student is under 18) Date ................
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