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Brockton Public School's HIGH SCHOOL TRANSCRIPT REQUEST FORM
STUDENT INFORMATION
Please complete the information below.
STUDENT NAME (as it appears on school records)
*
First Name
Middle Name
Last Name
DATE OF BIRTH
*
-
Month
-
Day
Year
Date
STUDENT ID
YEAR OF GRADUATION
*
If you did not graduate, please list the YEAR you SHOULD have graduated.
CURRENT ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Current Email address
*
example@example.com
TRANSCRIPT REQUEST DETAILS
REASON FOR REQUEST
COLLEGE APPLICATION
EMPLOYMENT
PERSONAL RECORDS
Other
I AM REQUESTING TRANSCRIPTS FROM
*
BROCKTON HIGH SCHOOL
EDISON DAY ACADEMY
EDISON EVENING ACADEMY
ADULT EDUCATION PROGRAM
Other
DELIVERY METHOD
*
PICK UP IN PERSON AT BHS MAIN OFFICE
THIRD PARTY OR SCHOOL
EMAIL TO PERSON REQUESTING TRANSCRIPT
Number of transcripts requested.
*
RECIPIENT INFORMATION (IF DIFFERENT FROM STUDENT)
RECIPIENT NAME / ORGANIZATION
STREET ADDRESS
City
State / Province
Postal / Zip Code
THIRD PARTY/ORGANIZATION EMAIL ADDRESS
example@example.com
I authorize the Brockton Public Schools to release my transcript to the designated recipient. Student Signature
*
Parent's Signature (for minors under 18)
PLEASE UPLOAD YOUR VALID PHOTO IDENTIFICATION (DRIVER'S LICENSE OR PASSPORT)
*
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PLEASE NOTE: There is a $5.00 fee (cash or money order only) per official transcript request. Please make the money order payable to: BROCKTON HIGH SCHOOL. Mail to: BROCKTON HIGH SCHOOL, ATTN: RECORDS OFFICE ,470 Forest Ave, Brockton, MA 02301. There is no charge for email (unofficial) transcripts.
If you have selected to PICK UP IN PERSON, please do so within 30 days. After 30 days, your transcript will be discarded, and you will have to submit a new transcript request.
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