Transcript Request Form (Former Student) - Harvard High School

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TRANSCRIPT REQUEST (FORMER STUDENT)
AUTHORIZATION FOR RELEASE OF SCHOOL RECORDS AND INFORMATION
Harvard School District 50, 401 North Division Street, Harvard IL 60033 815-943-4022
I hereby grant full permission to Harvard High School to release information concerning:
Name
(please print)
_____________________
Year of Graduation_________
ID number
(current student)
(if not current)
Please send my transcript to:
(School/Organization/Individual Organization/Self)
(Address)
(City, State, Zip Code)
Check items you wish to include:
Transcript
(includes record of grades, attendance, grade point average, rank in class etc.)
ACT / SAT Scores
Immunization
(only if the college you are going to attend requires
these and you have not already sent them with application for college)
Signed: ________________________________ Date of Signature___________
(Parent or Legal Guardian or Student)
(If student is 18 years of age or older, the parent may not sign for above records.)
$2.00 Fee Paid to Harvard Community School District 50
___________________________________________
___________________________
(Address )
(Telephone)
Date Received_______________ Initials_________
Date Printed________________ Initials_________
Date Mailed_________________ Initials_________

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