Brockton Public School's HIGH SCHOOL TRANSCRIPT REQUEST FORM

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 NameMiddle NameLast Name
DATE OF BIRTH*

MonthDayYear
Date
STUDENT ID
Did you graduate?*

YESNO
YEAR OF GRADUATION*
If you did not graduate, please list the YEAR you SHOULD have graduated.
CURRENT ADDRESS*

Street Address

Street Address Line 2

CityState / 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 APPLICATIONEMPLOYMENTPERSONAL RECORDSOther
I AM REQUESTING TRANSCRIPTS FROM*

BROCKTON HIGH SCHOOLCHAMPION HIGH SCHOOLEDISON EVENING ACADEMYADULT EDUCATION PROGRAMOther
DELIVERY METHOD*

PICK UP IN PERSON AT BHS MAIN OFFICETHIRD PARTY OR SCHOOLEMAIL TO PERSON REQUESTING TRANSCRIPT
Number of transcripts requested.*
Recipient Name

First NameLast Name
Recipient Email
example@example.com
RECIPIENT INFORMATION (for official transcripts only)

RECIPIENT NAME / ORGANIZATION

STREET ADDRESS

CityState / 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*

Clear
Parent's Signature (for minors under 18)

Clear
PLEASE UPLOAD YOUR VALID PHOTO IDENTIFICATION (DRIVER'S LICENSE OR PASSPORT)*

Cancelof
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.
Should be Empty:

Brockton Public School's HIGH SCHOOL TRANSCRIPT REQUEST FORM

TRANSCRIPT REQUEST DETAILS

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.