Request For Student Transcript - Pearl City High School
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1REQUEST FOR STUDENT TRANSCRIPT
Pearl City High School
Use a separate form for each request
$1.00 per request. Cash, money order, or cashier’s check only – no personal checks accepted.
Processing time is 3 – 5 business days.
Last Name: ___________________________ First Name: ___________________________ MI: _______
(Name used while attending PCHS)
Address: _____________________________________ Contact Phone No.: _______________________
_____________________________________ E-Mail Address: _________________________
Present Grade / Year Graduated / Year Withdrew: _________________ Date of Birth: _____/_____/_____
(Please circle one)
Transcript must include the following (check all that apply):
_____ All test scores (high school – SAT, PSAT, ACT, etc.)
_____ Grades 9 – 11, and Senior courses in progress
st
_____ Grades 9 – 11, and 1
Semester Senior grades (available in January)
_____ Final Transcript (8 semester grades including graduation date)
_____ Other: Please specify: _________________________________________________________
SEND OFFICIAL TRANSCRIPT TO:
PLEASE PRINT LEGIBLY!
Name: ________________________________________________________
Address: ________________________________________________________
________________________________________________________
City: ________________ State: ______ ZIP Code: __________________
*
DO NOT MAIL TRANSCRIPT
:
___ Forward to Mr. Mark Oda (
) OR ___ Pick up PERSONALLY on _________
Current PCHS students only
(date)
____ Official or ____ Unofficial
_____ Request _________________________
(name of person)
For ___________________________
pick up on _____________________________
.
(date)
(State the college or scholarship)
*OFFICIAL transcripts are mailed directly from the registrar’s office to an institution – no exceptions. All
other transcripts (e.g. hand-carried, personal) are marked UNOFFICIAL.
____________________________________________________
Date: ___________________
Signature of Parent/Guardian or Student (18+ years of age)
OFFICE USE ONLY:
Date Request Received: ________________________
Fee Collected:
Date Transcript Issued: ________________________
_______ $1.00
2100 Hookiekie Street, Pearl City, HI 96782
Revised 02/2012
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