Mdhsa Transcript Request
ADVERTISEMENT
1Office use only
____________________Date received at MDHSA
Date mailed to college(s) ____________________
MDHSA Transcript Request
_____
Check here IF THIS IS A RUSH ORDER
.
(needed in fewer than 7 business days, excluding holidays, weekends, and/or inclement weather)
Enclose an additional $15.
Student:
___________________________________Ph. #__________________Graduation year_______ GPA________
(Maiden Name)
(GPA may be needed for 2013 graduates or earlier)
Address: ______________________________________________________________________ E-mail________________________
2013 Graduates and earlier ONLY: SS # ___________________ and DOB ________________
(Complete only if not previously provided on Registration Form)
NOTES TO 2014 GRADUATES AND LATER:
The MDHSA office should be in possession of a current, Evaluator-signed, hard-copy Transcript. If it is necessary for the Transcript to reflect courses
being studied during the senior year, precede the course title with a ^. When the course(s) have been completed, delete the ^.
DO NOT ENTER A CREDIT FOR A COURSE CONTAINING a ^.
MDHSA will NOT enter items such as Senior Year Courses, SAT Scores, or GPA, unless a digital copy of the Transcript has been received by the
office (mdhsadpforms@pa.net). Please follow the instructions in the MDHSA Diploma Guide for instructions on entering this information onto
the Transcript.
Check here if you have emailed the digital Transcript to mdhsadpforms@pa.net
FEES:
Transcripts are $5.00 each. Additional Charges: RUSH processing -- Add $15.00 to the Transcript total.
Multiple Envelopes - -
Please check this box if multiple Transcripts are being mailed to the same address, and must be in separate sealed
envelopes. If not indicated, then the Transcripts will be loose in one large envelope.
While Transcripts are usually sent within a week or less, MDHSA reserves the right to allow two weeks to process this request.
List below colleges or other interested parties that desire to receive Transcripts.
1.
COLLEGE / INSTITUTION NAME: __________________________________________________________________________
Street Address: _____________________________________
City, State, Zip _________________________________________
Phone Number: _________________________________________ Multiple Envelope (Indicate the number of Transcripts requested: _____)
2.
COLLEGE / INSTITUTION NAME: __________________________________________________________________________
Street Address: _____________________________________
City, State, Zip _________________________________________
Phone Number: _________________________________________ Multiple Envelope (Indicate the number of Transcripts requested: _____)
3.
COLLEGE / INSTITUTION NAME: __________________________________________________________________________
Street Address: _____________________________________
City, State, Zip _________________________________________
Phone Number: _________________________________________ Multiple Envelope (Indicate the number of Transcripts requested: _____)
4.
COLLEGE / INSTITUTION NAME: __________________________________________________________________________
Street Address: _____________________________________
City, State, Zip _________________________________________
Phone Number: _________________________________________ Multiple Envelope (Indicate the number of Transcripts requested: _____)
PAYMENT INFORMATION: Please make checks payable to MDHSA.
MAIL TO: MDHSA Transcript Request, 32 West Main Street #5, Waynesboro, PA 17268
Number of transcripts (all institutions combined) ________ x $ 5.00 = $ ____________
RUSH fee (per Transcript Request Form)
$15.00 = $ ____________
TOTAL ENCLOSED $ ___________ Check #_______ Date: ________
*AUTHORIZED SIGNATURE (parent or student only) ______________________________________
(Signature is required to release the records to the above-listed facilities.)
____I have enclosed stamped # 10 envelopes addressed to the colleges to expedite mailings (optional).
To receive confirmation of receipt of this form, enclose an additional self-addressed stamped postcard/envelope with the words “TR form
received.” PLEASE DO NOT REQUIRE A SIGNATURE FOR DELIVERY to confirm receipt of this form.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business