Transcript Request Form - The Consolidated School District Of New
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1NEW BRITAIN HIGH SCHOOL
GUIDANCE DEPARTMENT
110 Mill Street, New Britain, CT 06051
Phone: (860) 225-6300 / Fax: (860) 224-2077
TRANSCRIPT REQUEST
Name: _______________________________________ Date of Birth: ______________
Maiden Name: _________________________________ SS#: xxx – xx - ____________
(
Last 4 digits only)
Send Transcript to:
______________________________________________________
______________________________________________________
______________________________________________________
Graduation Year _______________________ [Non-grade] Year Left ________________
New Britain High School ______ Pulaski High School _________ Adult Ed/GED _____
New Britain Adult Diploma Program __________ New Britain Academy _________
Present Address: _________________________________________________________
__________________________________Zip Code: ______________
Telephone: ________________________________________Fee $5.00 _____________
Please read carefully:
Each request for a transcript requires a signed Release of Information or equivalent before the transcript can
be mailed out.
Please indicate if you also need SAT/ACT scores or immunization records. They are not sent out
automatically.
There is a$5.00 fee
for a regular transcript (payable to New Britain High School) in cash, check or money
order before the transcript will be sent out. A request for anything additional may result in added fees
. immunizations only $2.00).
(i.e
A transcript sent directly or hand carried to the student will be unofficial.
minimum of two days
A
is required for processing the request.
RELEASE OF INFORMATION
I hereby authorize the New Britain High School Guidance Department to disclose to the designated representative of schools, colleges,
universities, industry, business, etc. information concerning my scholastic performance and attendance record and any other
information requested while a student at New Britain High School. I hereby release you from any and all liability or damages for
I give permission for New Britain High School to release any SAT/ACT
providing the information requested.
scores as part of my transcript.
_______________________________________________________
_____________________
Signature
Date
Rev.7/2013
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