09-11-19-hv
ROYCEALEE J. WOOD MICHAEL MUNDA
Regional Superintendent of Schools Assistant Regional Superintendent of Schools
ILLINOIS HIGH SCHOOL EQUIVALENCY CERTIFICATE OR TRANSCRIPT REQUEST FORM
PLEASE PRINT DATE:
Name Phone Number
Address
City State Zip
Date of Birth Last 4 Digits of SS Number
Email Address
Location of Test: Grayslake Waukegan
Last Name at time of Testing
Year of Test Completion
Request will not be processed without this information.
Official Transcript $10.00
Certificate $10.00
We accept personal checks or cash. Please make the check payable to the LAKE COUNTY REGIONAL
OFFICE OF EDUCATION. There will be a $20.00 charge for returned checks.
Transcript and/or certificate should be sent to:
Signature of Applicant
Cannot be processed without a signature
OFFICE USE ONLY:
Request Received Date Issued
Amount Received Cash Check Credit Card Payment
Transcript and/or Certificate Mailed Processed in Person
REGIONAL OFFICE OF EDUCATION
800 Lancer Lane Suite E-128
Grayslake, IL 60030-2656
Phone: 847/543-7833
www.lake.k12.il.us
Send fee and request form to:
Lake County Regional Office of Education
800 Lancer Lane Suite E-128
Grayslake, IL 60030-2656
If you would like to pay online
with a credit card, please contact
Hilda Vara, 847-665-
hvara@lake.k12.il.us
There will a $1.00 service fee per
document for credit card
payments.
