Transcript Request

Transcript Request

Perth Amboy Tech/Magnet School Transcript Release Request
Federal and State Law prohibit the release of pupil records without parent or adult student written authorization. The school cannot release records without this permission.

Ref. New Jersey Administrative code #6:3.1 et seq. states, “Organizations, agencies and persons from outside the school shall have access to pupil records if they have written consent of parent or adult pupil (age 18).”

I have read the above statement and pursuant to the law, I hereby authorize the release of a copy of the transcript concerning the student named below to outside school agencies.

YOU DO NOT NEED TO FILL OUT THIS FORM IF WE ARE ISSUING THE TRANSCRIPT DIRECTLY TO YOU.

Call 732-376-6300 x6340 for those requests.
Name

First NameMiddle NameLast Name
Phone Number*
Format: (000) 000-0000.
High School Graduation Date*

MonthDayYear
College #1*

School Name

School Email Address or Mailing Address

CityState / Province

Postal / Zip Code
College #2

School Name

School Email Address or Mailing Address

CityState / Province

Postal / Zip Code
College #3

School Name

School Email Address or Mailing Address

CityState / Province

Postal / Zip Code
Signature of Parent or Student (age 18+)*

Clear
Address all questions to Ms. Elizabeth Mullican, mullicane@mcmsnj.net.
Should be Empty: