Staples High School Secondary School Report Form
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1STAPLES HIGH SCHOOL
70 North Avenue, Westport, Connecticut 06880
Guidance Department
Phone: (203) 341-1225
Fax: (203) 341-1235
Secondary School Report Form
Instructions: Students complete Section I, then print, sign, and submit the Secondary School Report Form as part
of the transcript request. Counselors will complete Sections II & III.
Section I – (to be completed by student)
Name of Student:
First
MI
Last
Address:
Number & Street
Town
State
Zip Code
Email:
Phone:
Date of Birth:
/
/
□
□
I recognize the confidential nature of this document and I
do
do not waive my right to access.
Student Signature:
Date:
Section II & III – (to be completed by school counselor)
High School: Staples High School
High School CEEB: 070920
Address: 70 North Avenue, Westport, CT 06880
School Counselor’s Name:
Phone:
Fax: (203) 341-1235
Email:
@westport.k12.ct.us
Grading Scale: 4.0
Passing Grade: D- (60)
th
Student’s 6
Semester Academic (Weighted) GPA:
We do not rank students.
School Counselor Statement: See attached letter of recommendation.
School Counselor Signature:
Date:
Revised 6/2012
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