High School Former Student Transcript Request Form

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Lee’s Summit North High School
Former Student Transcript Request Form
Name________________________________________________________
(name while attending LSN)
Current name if different_________________________________________
Address_______________________________________________________
City____________________________ State __________ Zip___________
Telephone Number______________________________________________
Email Address__________________________________________________
Date of Birth ____________________
Graduation Year or Intended Year of Graduation______________________
MAIL/FAX INFORMATION TO:
College/University/Other__________________________________________________
Address_______________________________________________________
City/State/Zip__________________________________________________
Fax Number__________________________ _________________________
SIGNATURE __________________________ DATE ___________
FAX: 816/986-3172 OR MAIL TO: Lee’s Summit North High School
Office of the Registrar
901 NE Douglas
Lee’s Summit, MO 64086
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