High School Transcript Request Form
For Former Students
Student Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
School
*
Please Select
Bergen ASCS High
Passaic ASCS High
Paterson ASCS High
Graduation Year
*
Email
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Transcript Recipient Information
Name of Institution or Recipient
*
Recipient's Title/Department & Phone Number (if applicable):
Recipient's Email Address (if applicable):
Mailing Address (if applicable):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Transcript Delivery and Type
Please select your preferred delivery method
*
Mail (Standard delivery through postal service)
Electronic (Emailed directly to the institution or recipient)
Pickup (Transcript can be picked up in person with an ID)
Transcript Type. Please specify the type of transcript you are requesting
*
Official
Unofficial
Both Official and Unofficial
Authorization
I, the undersigned, hereby authorize my school to release my academic records, including transcripts and any necessary supporting documents, to the recipient specified above. I understand that this information will be used solely for the purpose of my application or registration with the institution or organization mentioned.
Student Signature
*
Date
*
-
Month
-
Day
Year
Date
Parent Signature (if student is under 18)
Date
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
Should be Empty: