PLEASE READ THE INFORMATION BELOW THE TRANSCRIPT PRIOR TO PRINTING.
This form must be printed and mailed to;
POLE HSSG & RC
417 N Rice Avenue
Louisa, KY 41230 Date Request Mailed _________________________
Students Full Name _______________________________________________________________
Date Student Graduated (MANDATORY)________________________ (must match diploma)
Current Address of student ________________________________________________________
Current Phone Number to be reached; _____________________________________
Date of Birth_____________________________ SS#____________________________________
The college I am registering for is __________________________________________________
I plan to begin my degree program on _______________________________________________
Degree I am taking is _____________________________________________________________
My student ID number is __________________________________________________________
This transcript needs to be:
Faxed to ________________________________ Attention________________________________
Mailed to ________________________________________________________________________
I understand that the information is needed to fill this request and it must be neat and completed with all information asked. I have also read the information below about the transcript request. I also understand that should this be mailed to my home, I can not open the transcript as it must be received from the school unopened. If opened, it then becomes unofficial. While all transcripts are free, should I open the transcript, I will have to pay a $5.00 fee to get one resent because I was told prior about this. I also understand that this can not be given at the last minute request; per policy, it can take up to 14 days to get the transcript.
Signature (student 18 years+)_______________________________________________________
Signature (student under 18)_______________________________________________________
Parent Signature (student under 18) ________________________________________________
for office use; Initials of Attendant
Date Received________________________________________ _____________
Date mailed/faxed ____________________________________ ______________
Please print the form and mail it into the office for a transcript.
The student is either graduating or graduated from high school. Please know that our list of students is growing and that there are times when we are closed and there are deadlines. The student that you are requesting a transcript form (even yourself) for will certainly have deadlines and have to follow directions. If these directions are not followed, there are surly consequences.
* Transcripts must be requested by a transcript request,
* This request may take up to 2 weeks to get them to you or the college; that is the max. However, there will not be sent out with a 24-72 hour turn around. Taking a look at the college, your college will not send these request out this quickly.
* Calling me a day or so after the request is sent is ok to ensure this has been received, but not to ask for the transcript; it can get to you within 2 weeks. (7-10 business days)
* I must have the entire request with student signature or request will not be filled.
This is a private run office and when the office is closed, transcript orders will be filled only when the office reopens.
Please note the following;
* Please make sure the writing is neat. I have to be able to read what is being placed on the form.
* The date that is one your diploma is mandatory or the request can not be filled.
* It is better to get a transcript release form from the college of your choice
* If this form is not filled out completely, you will get this back in the mail with the areas highlighted and will need to complete and resend this. Please make sure you attach any reasons as to why this is not being sent to a college if you choose not to give one; it is more legal if received by a school to the school.
* When colleges receive the transcript, it must be sealed. So, if you ask me to mail them to your home, do not open the letter when you get it and ensure that it remains sealed.
This request can not be granted until after your graduation date
unless requested by a college.
Please sign stating that you have read the above and understand this
Student Signature and Date