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					                                          CHESAPEAKE PUBLIC SCHOOLS
                                           TRANSCRIPT REQUEST FORM
                               ALL OFFICIAL TRANSCRIPTS ARE $2.00 PER TRANSCRIPT


NAME__________________________________________________________________________
             LAST                            First                     Middle

ADDRESS_______________________________________________________________________
                Street            City       State             Zip

PHONE________________________________YEAR OF GRADUATION___________________

*Please return with this request the SECONDARY SCHOOL REPORT form from the college application.

I authorize the release of transcripts of the information checked:

________ Grades and SAT/ACT, PSAT, AP scores                                                    ________ Grades only

________ SAT/ACT, PSAT, AP scores only

to the school/s or organization/s listed below:

NAME__________________________________________________________________________

ADDRESS_______________________________________________________________________

________________________________________________________________Zip____________

NAME__________________________________________________________________________

ADDRESS_______________________________________________________________________

________________________________________________________________Zip____________

PLEASE LIST ADDITIONAL SCHOOLS OR ORGANIZATIONS ON BACK OF FORM


                                                         ____________________________________________________
                                                                             Signature

                                                          ____________________________________________________
                                                          Signature of parent or guardian if under 18 years of age

Please check one:

*Note: The high school is allowed 14 working days to return your transcript.

________ Pick up this transcript in Guidance office in a sealed envelope within two weeks.*

________ This is an unofficial transcript for students personal use. NO CHARGE

-------------------------------------------------------------------------------------------------------------------------------------------------
---

For Office Use Only:                  Date Received____________                   Date Ready___________
                       MID YEAR TRANSCRIPTS
              ALL TRANSCRIPTS ARE $2.00 PER TRANSCRIPT


NAME:
___________________________________________________________________
           Last                         First
Middle

 ADDRESS:
_________________________________________________________________


NAME OF COLLEGE:
_____________________________________________________________

       ADDRESS: ____________________________________________________



NAME OF
COLLEGE:____________________________________________________________
_


ADDRESS:____________________________________________________


                                      ___________________________
                                          Signature

____ Transcript only

____ Transcript and S.A.T. scores


________________
____________________
      Date Received
Date Mailed

				
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