Student Records Request printable pdf download

Student Records Request

Grant Parish Public Schools

Student Records Request

To request a transcript or a duplicate diploma, please print and complete this form. Mail,

email, hand deliver, or fax the form to the address below. Records will be available to pick up

two weeks after the date request is received. Payment in the form of a money order must

accompany this request or be paid at the time of pick up. A copy of the student’s driver’s

license or state-issued ID must accompany request for transcripts and duplicate diplomas.

Grant Parish Public Schools

Attn: Jane Seward

P.O. Box 208

Colfax, LA 71417

Phone: (318)-627-3274

Fax: (318)-627-2842

_____ Transcript ($2:00 charge)

_____ Duplicate Diploma Request ($10.00 charge)

Date of Request: ______________

Daytime Contact Phone: (

) _____________

Student’s Name: _____________________________________________________________

Last

First

Middle

Maiden

Last 4 Digits of Social Security Number: ___________

Date of Birth: __________________

Month/Day/Year

High School Attended ___________________________

Date of Graduation: ____________

or Last date of Attendance

Method of delivery:

_____ Will be picked up by (Name) ______________________________ (ID required)

_____ Mail transcript to this address _______________________________________

_______________________________________

_____ Fax transcripts to: (____) ____________

Authorization to release: _______________________________

____________________

Signature

Date

Print Name: __________________________________________

Office Use Only: Date Received _________________ By: ________________

Date Processed: ____________ By: ________________ Amt. Paid: $______

Student Records Request