Transcript Release Form

Transcript/Records Release Request
بسم الله الرحمن الرحيم

In the name of God, the extremely merciful, the eternally merciful.
To the applicant: Upon your completion, Al Salaam Academy will submit this transcript/records release request form on your behalf to your previous school, as detailed below.

Authorization of release of educational records to Al Salaam Academy.

In accordance with regulations regarding the privacy rights of parents and students, the undersigned hereby consent to the immediate release to Al Salaam Academy of all educational records, including official transcripts, current grades in courses, test profiles, educational evaluations, and recommendations.
Name*

First NameLast Name
Name of School*
Dates of Attendance*
Principal/Guidance Counselor*

PrefixFirst NameLast Name
Principal/Guidance Counselor Email*
example@alsalaamacademy.org
Principal/Guidance Counselor Phone*
Please enter a valid phone number.
Name of Parent/Guardian Requesting Records
Name*

First NameLast Name
Signature of Parent/Guardian*

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Date of Request*

MonthDayYear
Date
Should be Empty:

Transcript/Records Release Request