SAMPLE
XYZ Charter
719
361/555-1234
Transcript Request
__________________________________________________________________________________
LAST NAME (Please
Print)
FIRST NAME M.I.
__________________________________________________________________________________
GRADE
TODAY’S DATE
__________________________________________________________________________
BIRTHDATE
SSN ADVISOR
Please send the following information:
(Check Choice)
FRONT ONLY: FRONT
and BACK:
Information includes demographic
data, Information includes standardized
grades completed, credits
test scores: TAKS, TAAS, PSAT,
SAT-I, SAT-II, ACT
SEND INFORMATION TO: __________________________________________
NAME
OF SCHOOL, COLLEGE, SCHOLARSHIP
__________________________________________
STREET ADDRESS
__________________________________________
CITY, STATE, ZIP
________________________________________________ ___________________________
SIGNATURE OF PERSON REQUESTING
TRANSCRIPT RELATIONSHIP TO
STUDENT
(Must be over 18 years of age.)
PLEASE
SEND __________ I WILL PICK UP
___________ GIVE TO COUNSELOR__________
UNOFFICLAL
COPY ONLY
REMEMBER TO PROVIDE
ADDRESSED, STAMPED ENVELOPES FOR MAILING OF OFFICIAL TRANSCRIPTS.
II. 7