Questions? Call 1-800-382-6010
Official Transcript Request Form
Use this form to request a copy of your official transcript. Complete and submit this form to your school principal or school counselor.
Transcripts are notarized with an official Connections Academy seal and signed by a school official. Only parents, guardians, and
students age 18 and older may request the release of official transcripts.
Requestor Information
Last Name First Name Middle Name County
Street Address City State ZIP Code
( ) ( ) ( )
Home Phone Work Phone Mobile Phone
I
s the student the requestor? Yes No If no, please fill out the student information below.
Student’s Last Name Student’s First Name Student’s Middle Name Relationship of requestor to student
Transcript Destinations
Destination 1: Name of School or Agency County
Street Address City State ZIP Code
Send on date
Send to the attention of # of Transcripts
Destination 2: Name of School or Agency County
Street Address City State ZIP Code
Send on date
Send to the attention of # of Transcripts
Destination 3: Name of School or Agency County
Street Address City State ZIP Code
Send on date Send to the attention of # of Transcripts
Parent/Guardian Approval
By signing below, I give permission for Connections Academy to send official transcripts to the above locations.
© 2010 Connections Academy
®
, LLC. Questions? Call 1-800-382-6010. www.connectionsacademy.com
Parent/Guardian Name Parent/Guardian Signature Date
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signature
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